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2026 Session

Budget Amendments - SB30 (Committee Approved)

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State Health Plan Coverage of Weight Loss Drugs (language only)

Item 75 #1s

Item 75 #1s

Administration
Administration of Health Insurance

Language

Page 79, after line 35, insert:

"I. The Department of Human Resource Management (DHRM) shall, through its contracted actuary, evaluate pharmaceutical manufacturer programs and other contracting arrangements available to self-insured health insurance programs that are intended to reduce the costs of glucagon-like peptide-1 (GLP-1) receptor agonists and related therapies. The evaluation shall include: (i) a review of manufacturer-sponsored programs and any other contractual arrangements that are available; and (ii) an assessment of the fiscal impact and feasibility associated with participation in such programs or arrangements. DHRM shall project cost savings for such programs or contracting arrangements and shall be authorized to implement the program or arrangement with the greatest projected savings to the state health plan that also results in achieving the savings for the state health plan as included in Senate Bill 30, as introduced.  If DHRM determines that such savings cannot be achieved, then DHRM shall be authorized to impose increased cost-sharing for GLP-1 drugs prescribed for weight loss and add additional restrictions on GLP-1 drugs to achieve the savings.  Any changes to the state health plan pursuant to this paragraph requires 30 days prior notice to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees."



Explanation

(This amendment directs the Department of Human Resource Management (DHRM) to evaluate pharmaceutical manufacturer programs and other contracting arrangements available to reduce the costs of glucagon-like peptide-1 (GLP-1) receptor agonists and related therapies. DHRM must project cost savings for such programs or contracting arrangements and is authorized to implement the program or arrangement with the greatest projected savings to the state health plan.)