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Committee opens hearings on bills to add GLP‑1 obesity drugs to state health plans; fiscal questions remain
Summary
The House Human Services Committee opened hearings on House Bills 1451 and 1452 to add GLP‑1 anti‑obesity medications to coverage for Medicaid expansion enrollees and PERS participants. Lawmakers and health officials flagged fiscal‑note uncertainties and implementation details; both hearings were held open for further work.
The House Human Services Committee on Tuesday opened hearings on two bills that would expand coverage of GLP‑1 class anti‑obesity drugs for publicly insured North Dakotans, and left both hearings open for further work.
Representative John Nelson, sponsor of House Bills 1451 and 1452, told the committee HB1451 "would make GLP‑1 products available for anti obesity treatment to Medicaid expansion individuals." HB1452 would apply similar coverage to PERS participants and, as drafted, would operate as a two‑year pilot with a required report and an expiration date.
The bills drew technical and fiscal questions from committee members and Medicaid pharmacy staff. "The total number of people in this fiscal note is less than a thousand people," said Brandi Joyce, pharmacy and clinical services administrator for Medicaid, who also noted the agency uses confidential post‑rebate pricing for its fiscal calculations. Joyce told members the department used utilization percentages from other states that recently adopted coverage to estimate uptake and said she did not model drug shortage effects.
Nelson and supporters emphasized clinical eligibility limits written into the bills: a body‑mass index of 30, or 27 with another qualifying condition. Nelson said the measures "will affect dramatically heart disease, diabetes for sure and other conditions" and noted the drugs were added in some plans under the Affordable Care Act's essential health benefits.
Business groups raised cost concerns about HB1452. Eric Spencer, president and CEO of the Greater North Dakota Chamber, said his members worry about employer coverage costs because section 2 of HB1452 would require PERS to draft a bill applying similar requirements to private‑sector plans. "As drafted, we feel that this bill will make health insurance for employers more expensive," Spencer said, and he cited the bill's fiscal‑note estimate of a $72,000,000 premium impact to PERS.
Committee members repeatedly asked for better data for the fiscal note. Joyce said savings from weight loss often occur beyond the four‑year window used in fiscal notes and that plans that recently expanded coverage have seen higher near‑term per‑patient costs because of increased office visits and monitoring.
No votes were taken; the committee held both hearings open to allow staff and proponents to refine fiscal assumptions and implementation language before the bills advance.
Committee staff will work with the bill sponsors and agency experts on an updated fiscal note and language clarifications before reconvening the hearings.
