{ "title": "GLP-1 Insurance Coverage Mandates by State (2026)", "publisher": "Weight Loss Provider Guide Research", "creator": "Weight Loss Provider Guide Editorial Team", "last_verified": "2026-08-01", "scope": "50 U.S. states and the District of Columbia", "important_scope_note": "This is a legal-scope and policy-status dataset, not a live formulary or individual benefit lookup. A negative row means no tracked GLP-1-specific action was identified under the stated methodology as of the cutoff; it does not mean every insurer or public plan excludes GLP-1 drugs. The self-insurance field is employer-market context, not an estimate of the exact population reached by an EHB or public-program rule.", "methodology": [ "Scope: 50 states plus the District of Columbia, verified through August 1, 2026.", "Positive and high-risk rows were classified from final statutes, enrolled acts, current amended bills, CMS-approved benchmark documents, and official public-plan materials.", "Must-cover, must-offer, authorized, enacted-but-contingent, administrative/time-limited, express-exclusion, and proposed/failed/superseded actions remain separate statuses.", "A must-offer provision is not counted as automatic coverage. An authorization is not counted as a mandate.", "A broader obesity-drug EHB benefit may encompass FDA-approved GLP-1 drugs but does not guarantee every product, dose, or presentation.", "Negative rows are scoped audit conclusions based on current CMS benchmark status and official legislative/state-source review, not absolute legal opinions.", "Final operative text controls over drafts; current amended text controls over introduced or earlier versions.", "The self-insurance field comes from AHRQ MEPS-IC 2024 Table II.B.2.b.(1) and is contextual rather than a mandate-reach estimate.", "Every row carries a last-verification date, source URLs, document status, confidence, and publish status.", "No survey was conducted and no state coverage value was modeled or estimated." ], "columns": [ "Jurisdiction", "Overall classification", "Express GLP-1 private-market requirement", "Broader obesity-drug EHB benefit", "Individual / small-group scope", "Large-group scope", "Medicaid statutory status", "State employee-plan statutory status", "Operative note", "Authority / bill", "Effective or operative date", "Plans not reached / key caveat", "Primary source 1", "Primary source 2", "Audit / context source", "Document status / version", "Last verified", "Confidence", "Publish status", "Change-log note", "Private-sector employer enrollees in self-insured plans, 2024" ], "rows": [ { "Jurisdiction": "Alabama", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "59.4%" }, { "Jurisdiction": "Alaska", "Overall classification": "Final 2026 EHB benchmark excludes pharmaceutical obesity treatment; draft GLP-1 addition was not adopted", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No — final benchmark excludes obesity drugs", "Individual / small-group scope": "Final 2026 benchmark excludes surgical and pharmaceutical obesity treatment", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "An April 2024 draft contemplated adding GLP-1/GIP obesity-drug coverage, but the final operative document retained an obesity-drug exclusion.", "Authority / bill": "Alaska 2026 EHB Benchmark Plan", "Effective or operative date": "2026 plan year", "Plans not reached / key caveat": "Draft documents are not controlling; the final CMS-approved benchmark governs this row.", "Primary source 1": "https://www.commerce.alaska.gov/web/Portals/11/Pub/AK.EHBPlanDocument_2024.pdf", "Primary source 2": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Final operative EHB plan; draft-to-final reversal verified", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Version-control example: do not count the superseded draft.", "Private-sector employer enrollees in self-insured plans, 2024": "57.7%" }, { "Jurisdiction": "Arizona", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "69.5%" }, { "Jurisdiction": "Arkansas", "Overall classification": "Severe-obesity treatment mandate with an express weight-loss-drug exclusion", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "State-regulated health plans must cover specified severe-obesity treatment services beginning 2026, but the law does not require injectable glucose-lowering drugs or other drugs prescribed for weight loss", "Large-group scope": "State-regulated covered plans within the statutory definition; drug exclusion remains", "Medicaid statutory status": "Severe-obesity services required, but Medicaid is not required to cover injectable glucose-lowering drugs or other weight-loss drugs", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "The act is an obesity-treatment mandate, not a GLP-1 coverage mandate.", "Authority / bill": "Act 628 of 2025 / HB 1424", "Effective or operative date": "Private-plan provisions: 2026-01-01", "Plans not reached / key caveat": "Express statutory drug exclusion; do not classify Arkansas as mandating GLP-1 weight-loss coverage.", "Primary source 1": "https://arkleg.state.ar.us/Home/FTPDocument?path=%2FACTS%2F2025R%2FPublic%2FACT628.pdf", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Enacted final act", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Keep separate from drug-coverage mandates despite the act's obesity-treatment title.", "Private-sector employer enrollees in self-insured plans, 2024": "49.0%" }, { "Jurisdiction": "California", "Overall classification": "No enacted coverage mandate identified; 2026 bill is now a pricing/manufacturing access measure", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "SB 1089 originally contained a future CalPERS GLP-1 coverage-offer provision, but that language was struck from the June 18, 2026 amended version.", "Authority / bill": "SB 1089 (2025–2026), amended June 18, 2026", "Effective or operative date": "Pending as of 2026-08-01", "Plans not reached / key caveat": "The current bill text does not require an insurer or CalPERS plan to cover GLP-1 drugs.", "Primary source 1": "https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260SB1089", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Active bill; current amended text controls", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Version-control example: prior analyses of the struck CalPERS provision are stale.", "Private-sector employer enrollees in self-insured plans, 2024": "53.9%" }, { "Jurisdiction": "Colorado", "Overall classification": "Future large-group mandatory offer; GLP-1 coverage is not automatically included", "Express GLP-1 private-market requirement": "Offer requirement only", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1 drug mandate created by SB 25-048", "Large-group scope": "Beginning 2027, carriers offering state-regulated large-group plans must offer policyholders an option to purchase FDA-approved anti-obesity-drug coverage including at least one GLP-1 medication", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "The policyholder must elect and pay for the optional drug benefit; statutory exceptions may apply if premiums would not cover expected benefits.", "Authority / bill": "SB 25-048 / Chapter 365", "Effective or operative date": "2027-01-01", "Plans not reached / key caveat": "State-regulated large-group plans only; not self-funded ERISA plans and not automatic inclusion in every plan.", "Primary source 1": "https://leg.colorado.gov/laws/session-laws/SB25-048/365/download", "Primary source 2": "https://leg.colorado.gov/bills/sb25-048", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Enacted; future effective", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Label as MUST OFFER, never MUST COVER.", "Private-sector employer enrollees in self-insured plans, 2024": "52.9%" }, { "Jurisdiction": "Connecticut", "Overall classification": "Administrative state employee-plan coverage, GLP-1 reporting law, and Medicaid/CHIP authorization; no private-market mandate identified", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "Public Act 25-168 allows, rather than requires, the Department of Social Services to cover specified obesity treatments under Medicaid and CHIP", "State employee-plan statutory status": "Coverage operates through the state plan's medical weight-management program; Conn. Gen. Stat. § 5-259h requires annual GLP-1 utilization and cost reporting rather than creating the underlying benefit", "Operative note": "Connecticut combines administrative public-plan coverage, a reporting statute, and a separate public-program authorization. None is a private-market coverage mandate.", "Authority / bill": "Care Compass anti-obesity medication program; Conn. Gen. Stat. § 5-259h; P.A. 25-168", "Effective or operative date": "Current state-plan policy; P.A. 25-168 effective 2025-07-01", "Plans not reached / key caveat": "The Medicaid/CHIP provision is permissive, and administrative state-plan terms can change without a new coverage-mandate statute.", "Primary source 1": "https://carecompass.ct.gov/pharmacy/weight-loss-medications/", "Primary source 2": "https://prdext2.cga.ct.gov/2026/sup/chap_067.htm", "Audit / context source": "https://www.cga.ct.gov/2025/sum/pdf/2025SUM00168-R02HB-07287-SUM.pdf", "Document status / version": "Current program page, current reporting statute, and enacted authorization", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Expanded to include the Medicaid/CHIP authorization and corrected the BMI-40 step-therapy description in the article.", "Private-sector employer enrollees in self-insured plans, 2024": "59.4%" }, { "Jurisdiction": "Delaware", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "66.3%" }, { "Jurisdiction": "District of Columbia", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "53.2%" }, { "Jurisdiction": "Florida", "Overall classification": "Annual, capped state employee Weight Management Program; no permanent mandate identified; 2026 expansion bills died", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "The 2026 state group Weight Management Program provides a wellness program and FDA-approved weight-management medications for up to 2,800 eligible members, subject to annual legislative approval; HB 977 and SB 1070 would have created broader standing coverage but died", "Operative note": "A current annual public-plan program is real coverage, but it is not equivalent to a permanent statewide coverage mandate.", "Authority / bill": "2026 Florida Benefit Guide; HB 977 / SB 1070 (2026)", "Effective or operative date": "2026 program runs 2026-01-01 through 2026-12-31; bills died 2026-03-13", "Plans not reached / key caveat": "Program is capped at 2,800 members and remains subject to legislative approval; no enacted permanent state employee-plan GLP-1 mandate was identified at the cutoff.", "Primary source 1": "https://www.mybenefits.myflorida.com/content/download/438643/file/2026%20Florida%20Benefit%20Guide.pdf", "Primary source 2": "https://www.flsenate.gov/Session/Bill/2026/977", "Audit / context source": "https://www.flsenate.gov/Session/Bill/2026/1070", "Document status / version": "Current 2026 benefit guide plus failed 2026 proposals", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Added the operative 2026 annual program; retained the failed permanent-expansion bills as a separate status.", "Private-sector employer enrollees in self-insured plans, 2024": "65.2%" }, { "Jurisdiction": "Georgia", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "57.3%" }, { "Jurisdiction": "Hawaii", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "35.3%" }, { "Jurisdiction": "Idaho", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "44.4%" }, { "Jurisdiction": "Illinois", "Overall classification": "Current statutory mandate for the State Employees Group Insurance Program", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "Statutory mandate — all medically necessary injectable medicines prescribed on- or off-label to improve glucose or weight loss for qualifying adults", "Operative note": "Qualifying diagnoses include prediabetes, gestational diabetes, or obesity; continued coverage may require participation in a plan-administered lifestyle-management program.", "Authority / bill": "5 ILCS 375/6.11C", "Effective or operative date": "2024-07-01", "Plans not reached / key caveat": "Applies to the Illinois State Employees Group Insurance Program; excludes Medicare Advantage Prescription Drug Plan enrollees.", "Primary source 1": "https://ilga.gov/documents/legislation/ilcs/documents/000503750K6.11C.htm", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Codified current statute", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Keep in the public employee-plan category, not the private commercial category.", "Private-sector employer enrollees in self-insured plans, 2024": "48.0%" }, { "Jurisdiction": "Indiana", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "72.3%" }, { "Jurisdiction": "Iowa", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "62.3%" }, { "Jurisdiction": "Kansas", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "66.3%" }, { "Jurisdiction": "Kentucky", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "69.6%" }, { "Jurisdiction": "Louisiana", "Overall classification": "Two enacted public-program actions: contingent Medicaid requirement plus future voluntary employee-plan offer", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "Act 898 requires FDA-approved medically necessary weight-loss medications, permits prior authorization, and bars step therapy — but the coverage section becomes operative only when a specific legislative appropriation takes effect", "State employee-plan statutory status": "Act 749 requires the Office of Group Benefits to offer a voluntary comprehensive weight-management plan beginning 2027; the enrollee pays 100% of the premium", "Operative note": "Neither action should be described as a current blanket commercial insurance mandate.", "Authority / bill": "Act 898 / SB 433; Act 749 / SB 250", "Effective or operative date": "Medicaid: contingent on specific appropriation; OGB offer: 2027-01-01", "Plans not reached / key caveat": "Act 749 does not require existing OGB health plans to change medical-necessity, utilization-management, or formulary rules.", "Primary source 1": "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1481257", "Primary source 2": "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1480474", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Enacted final acts; one provision is appropriation-contingent", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Do not assign a fixed Medicaid coverage start date until the triggering appropriation is verified.", "Private-sector employer enrollees in self-insured plans, 2024": "54.4%" }, { "Jurisdiction": "Maine", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "42.7%" }, { "Jurisdiction": "Maryland", "Overall classification": "Medicaid coverage authorization, not a coverage mandate", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "Beginning 2027, the Maryland Medical Assistance Program is authorized to provide comprehensive obesity-treatment coverage; the department may seek federal approval", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "The enacted text uses permissive authorization language and does not compel the department to activate the benefit.", "Authority / bill": "SB 496 / Chapter 866 (2026)", "Effective or operative date": "Act effective 2026-10-01; authorization begins 2027-01-01", "Plans not reached / key caveat": "Do not count an authorization as an operative coverage mandate.", "Primary source 1": "https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0496?ys=2026RS", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Enacted final law", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Track later Medicaid implementation notices separately from the statute.", "Private-sector employer enrollees in self-insured plans, 2024": "48.6%" }, { "Jurisdiction": "Massachusetts", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "45.5%" }, { "Jurisdiction": "Michigan", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "48.4%" }, { "Jurisdiction": "Minnesota", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "54.8%" }, { "Jurisdiction": "Mississippi", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "65.5%" }, { "Jurisdiction": "Missouri", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "53.1%" }, { "Jurisdiction": "Montana", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "45.5%" }, { "Jurisdiction": "Nebraska", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "72.6%" }, { "Jurisdiction": "Nevada", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "61.2%" }, { "Jurisdiction": "New Hampshire", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "63.3%" }, { "Jurisdiction": "New Jersey", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "41.8%" }, { "Jurisdiction": "New Mexico", "Overall classification": "Current broader obesity-drug EHB benefit; not GLP-1-specific", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "Yes", "Individual / small-group scope": "Current EHB benchmark covers prescription drugs medically necessary for treatment of obesity and morbid obesity", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "The language can encompass FDA-approved obesity GLP-1 drugs, but it does not guarantee every product or eliminate formulary and medical-necessity controls.", "Authority / bill": "New Mexico 2022 EHB Benchmark Plan", "Effective or operative date": "2022 plan year and beyond", "Plans not reached / key caveat": "Not a product-specific mandate; does not reach self-funded employer plans and does not guarantee a named GLP-1.", "Primary source 1": "https://www.osi.state.nm.us/wp-content/uploads/nm_bmp.pdf", "Primary source 2": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Current CMS-approved EHB benchmark", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Classify separately from North Dakota's express GLP-1/GIP language.", "Private-sector employer enrollees in self-insured plans, 2024": "61.6%" }, { "Jurisdiction": "New York", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "55.9%" }, { "Jurisdiction": "North Carolina", "Overall classification": "Current broader FDA-approved obesity-drug EHB benefit; not GLP-1-specific", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "Yes", "Individual / small-group scope": "Benchmark plan provides prescription-drug coverage for FDA-approved drugs used for short- and long-term treatment of clinical obesity", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "The full plan document contains the drug benefit even though a high-level summary can appear to exclude 'weight loss programs'; programs and prescription drugs are distinct.", "Authority / bill": "North Carolina current EHB Benchmark Plan document", "Effective or operative date": "Current benchmark carried forward from the 2017 plan", "Plans not reached / key caveat": "Closed formulary, prior review, tiering, and plan administration may still affect which GLP-1 is covered.", "Primary source 1": "https://www.ncdoi.gov/documents/life-and-health/healthcare-law/2017-nc-ehb-benchmark-plan-bcbsnc-2017-plan-document/open", "Primary source 2": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Current CMS-listed benchmark plan document", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "Use the full plan text, not the summary-chart label alone.", "Private-sector employer enrollees in self-insured plans, 2024": "59.4%" }, { "Jurisdiction": "North Dakota", "Overall classification": "Current express GLP-1/GIP private-market EHB requirement", "Express GLP-1 private-market requirement": "Yes", "Broader obesity-drug EHB benefit": "Yes — express GLP-1/GIP language", "Individual / small-group scope": "Non-grandfathered ACA individual and small-group plans must include the benchmark benefit", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "The benchmark covers GLP-1 and GIP therapy for prevention of diabetes and treatment of insulin resistance, metabolic syndrome, or morbid obesity; prior authorization and cost sharing remain possible.", "Authority / bill": "North Dakota 2025 EHB Benchmark Plan", "Effective or operative date": "2025-01-01", "Plans not reached / key caveat": "Does not apply to PERS, grandfathered plans, large-group plans solely by virtue of EHB, or self-funded ERISA plans.", "Primary source 1": "https://www.insurance.nd.gov/sites/www/files/documents/Communications/Press%20Release%20Attachments/ND%20INS%20EHB%20Changes%20ND%20Legis.pdf", "Primary source 2": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Current CMS-approved EHB benchmark", "Last verified": "2026-08-01", "Confidence": "High", "Publish status": "Publishable with scope caveat", "Change-log note": "This is the only reviewed private-market benchmark that expressly names GLP-1/GIP drugs.", "Private-sector employer enrollees in self-insured plans, 2024": "57.6%" }, { "Jurisdiction": "Ohio", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "57.8%" }, { "Jurisdiction": "Oklahoma", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "56.9%" }, { "Jurisdiction": "Oregon", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "50.8%" }, { "Jurisdiction": "Pennsylvania", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "55.4%" }, { "Jurisdiction": "Rhode Island", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "47.7%" }, { "Jurisdiction": "South Carolina", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "54.0%" }, { "Jurisdiction": "South Dakota", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "54.0%" }, { "Jurisdiction": "Tennessee", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "63.2%" }, { "Jurisdiction": "Texas", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "61.9%" }, { "Jurisdiction": "Utah", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "63.8%" }, { "Jurisdiction": "Vermont", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "62.8%" }, { "Jurisdiction": "Virginia", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "62.6%" }, { "Jurisdiction": "Washington", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "59.3%" }, { "Jurisdiction": "West Virginia", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "63.4%" }, { "Jurisdiction": "Wisconsin", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "60.3%" }, { "Jurisdiction": "Wyoming", "Overall classification": "No tracked GLP-1-specific action identified under this methodology", "Express GLP-1 private-market requirement": "No", "Broader obesity-drug EHB benefit": "No identified", "Individual / small-group scope": "No GLP-1-specific requirement identified", "Large-group scope": "No GLP-1-specific requirement identified", "Medicaid statutory status": "No enacted obesity-drug coverage mandate identified", "State employee-plan statutory status": "No enacted GLP-1-specific mandate identified", "Operative note": "This is a scoped audit finding, not a statement that every insurer, employer plan, Medicaid contractor, or public plan excludes GLP-1 drugs.", "Authority / bill": "WPG 51-jurisdiction legal-scope audit", "Effective or operative date": "", "Plans not reached / key caveat": "Voluntary formularies, employer elections, administrative public-plan coverage, and non-obesity indications may differ.", "Primary source 1": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "Primary source 2": "", "Audit / context source": "https://www.ncsl.org/health/prescription-drug-legislation-database", "Document status / version": "Audit conclusion based on current CMS benchmark status and official legislative/state-source review", "Last verified": "2026-08-01", "Confidence": "Moderate", "Publish status": "Publishable with scope caveat", "Change-log note": "Recheck current EHB documents and the official state legislative database at the next refresh.", "Private-sector employer enrollees in self-insured plans, 2024": "59.4%" } ], "legislation_and_actions": [ { "Jurisdiction": "Alaska", "Action": "2026 EHB benchmark", "Status": "Final benchmark excludes obesity drugs", "Coverage-system": "ACA individual/small group", "Legal effect": "No GLP-1 mandate; final text controls over draft", "Effective date": "2026 plan year", "Primary source": "https://www.commerce.alaska.gov/web/Portals/11/Pub/AK.EHBPlanDocument_2024.pdf", "Version note": "Draft-to-final reversal", "Last verified": "2026-08-01" }, { "Jurisdiction": "Arkansas", "Action": "Act 628 / HB 1424", "Status": "Enacted", "Coverage-system": "Medicaid and state-regulated private plans", "Legal effect": "Mandates specified severe-obesity services but expressly does not require injectable glucose-lowering or weight-loss drugs", "Effective date": "Private provisions 2026-01-01", "Primary source": "https://arkleg.state.ar.us/Home/FTPDocument?path=%2FACTS%2F2025R%2FPublic%2FACT628.pdf", "Version note": "Final act", "Last verified": "2026-08-01" }, { "Jurisdiction": "California", "Action": "SB 1089", "Status": "Pending; amended June 18, 2026", "Coverage-system": "Pricing/manufacturing access", "Legal effect": "Current version authorizes GLP-1 manufacturing/pricing partnerships; struck prior CalPERS coverage-offer language", "Effective date": "Pending", "Primary source": "https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260SB1089", "Version note": "Current amended text controls", "Last verified": "2026-08-01" }, { "Jurisdiction": "Colorado", "Action": "SB 25-048 / Ch. 365", "Status": "Enacted; future effective", "Coverage-system": "State-regulated large group", "Legal effect": "Carrier must offer an optional anti-obesity-drug benefit including at least one GLP-1; not automatic coverage", "Effective date": "2027-01-01", "Primary source": "https://leg.colorado.gov/laws/session-laws/SB25-048/365/download", "Version note": "Final session law", "Last verified": "2026-08-01" }, { "Jurisdiction": "Connecticut", "Action": "State-plan program; Conn. Gen. Stat. § 5-259h; P.A. 25-168", "Status": "Current administrative coverage, current reporting law, and enacted authorization", "Coverage-system": "State employee and retiree plan; Medicaid/CHIP", "Legal effect": "Administrative anti-obesity-medication coverage; annual GLP-1 reporting; Medicaid/CHIP coverage permitted rather than required", "Effective date": "Current policy; P.A. 25-168 effective 2025-07-01", "Primary source": "https://carecompass.ct.gov/pharmacy/weight-loss-medications/", "Version note": "Keep administrative coverage, reporting, and authorization as separate effects", "Last verified": "2026-08-01" }, { "Jurisdiction": "Florida", "Action": "2026 Weight Management Program; HB 977 / SB 1070", "Status": "Current annual program; expansion bills died 2026-03-13", "Coverage-system": "State group health plan", "Legal effect": "Annual program provides FDA-approved weight-management medication to up to 2,800 eligible members; failed bills did not create permanent coverage", "Effective date": "2026-01-01 through 2026-12-31, pending legislative approval", "Primary source": "https://www.mybenefits.myflorida.com/content/download/438643/file/2026%20Florida%20Benefit%20Guide.pdf", "Version note": "Current benefit guide controls for 2026; failed bill status remains separate", "Last verified": "2026-08-01" }, { "Jurisdiction": "Illinois", "Action": "5 ILCS 375/6.11C", "Status": "Current law", "Coverage-system": "State Employees Group Insurance Program", "Legal effect": "Requires medically necessary injectable medicines to improve glucose or weight loss for qualifying adults", "Effective date": "2024-07-01", "Primary source": "https://ilga.gov/documents/legislation/ilcs/documents/000503750K6.11C.htm", "Version note": "Codified current statute", "Last verified": "2026-08-01" }, { "Jurisdiction": "Louisiana", "Action": "Act 898 / SB 433", "Status": "Enacted; coverage trigger contingent", "Coverage-system": "Medicaid", "Legal effect": "Requires FDA-approved medically necessary weight-loss medications; PA allowed; step therapy barred; operative only after a specific appropriation", "Effective date": "Contingent on appropriation", "Primary source": "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1481257", "Version note": "Final enrolled act", "Last verified": "2026-08-01" }, { "Jurisdiction": "Louisiana", "Action": "Act 749 / SB 250", "Status": "Enacted; future offer", "Coverage-system": "Office of Group Benefits", "Legal effect": "Must offer a voluntary comprehensive weight-management plan; enrollee pays 100% of premium; existing formularies need not change", "Effective date": "Offer begins 2027-01-01", "Primary source": "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1480474", "Version note": "Final enrolled act", "Last verified": "2026-08-01" }, { "Jurisdiction": "Maryland", "Action": "SB 496 / Ch. 866", "Status": "Enacted authorization", "Coverage-system": "Medicaid", "Legal effect": "Authorizes, but does not require, comprehensive obesity-treatment coverage beginning 2027", "Effective date": "Act 2026-10-01; authorization 2027-01-01", "Primary source": "https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0496?ys=2026RS", "Version note": "Final enacted law", "Last verified": "2026-08-01" }, { "Jurisdiction": "New Mexico", "Action": "2022 EHB benchmark", "Status": "Current", "Coverage-system": "ACA individual/small group", "Legal effect": "Covers prescription drugs medically necessary for obesity and morbid obesity; not GLP-1-specific", "Effective date": "2022 and beyond", "Primary source": "https://www.osi.state.nm.us/wp-content/uploads/nm_bmp.pdf", "Version note": "Current CMS-approved benchmark", "Last verified": "2026-08-01" }, { "Jurisdiction": "North Carolina", "Action": "Current EHB benchmark document", "Status": "Current", "Coverage-system": "ACA individual/small group", "Legal effect": "Covers FDA-approved prescription drugs for short- and long-term treatment of clinical obesity; not GLP-1-specific", "Effective date": "Current benchmark", "Primary source": "https://www.ncdoi.gov/documents/life-and-health/healthcare-law/2017-nc-ehb-benchmark-plan-bcbsnc-2017-plan-document/open", "Version note": "Full plan text controls over summary label", "Last verified": "2026-08-01" }, { "Jurisdiction": "North Dakota", "Action": "2025 EHB benchmark", "Status": "Current", "Coverage-system": "ACA individual/small group", "Legal effect": "Expressly covers GLP-1 and GIP therapy for specified metabolic conditions and morbid obesity", "Effective date": "2025-01-01", "Primary source": "https://www.insurance.nd.gov/sites/www/files/documents/Communications/Press%20Release%20Attachments/ND%20INS%20EHB%20Changes%20ND%20Legis.pdf", "Version note": "Current CMS-approved benchmark", "Last verified": "2026-08-01" } ], "sources": [ { "organization": "CMS", "use": "Current EHB benchmark plans for 50 states and D.C.; scope of EHB", "url": "https://www.cms.gov/marketplace/resources/data/essential-health-benefits", "source_type": "Primary federal source", "last_checked": "2026-08-01" }, { "organization": "U.S. Department of Labor / CMS", "use": "EHB not required of self-insured and large-group plans solely under federal EHB rules", "url": "https://www.cms.gov/cciio/resources/files/downloads/ehb-faq-508.pdf", "source_type": "Primary federal source", "last_checked": "2026-08-01" }, { "organization": "U.S. Code", "use": "Medicaid may exclude agents when used for weight loss", "url": "https://uscode.house.gov/quicksearch/get.plx?section=1396r-8&title=42", "source_type": "Primary federal law", "last_checked": "2026-08-01" }, { "organization": "North Dakota Insurance Department", "use": "2025 EHB scope, GLP-1/GIP benefit, prior authorization and cost-sharing notes", "url": "https://www.insurance.nd.gov/sites/www/files/documents/Communications/Press%20Release%20Attachments/ND%20INS%20EHB%20Changes%20ND%20Legis.pdf", "source_type": "Primary state source", "last_checked": "2026-08-01" }, { "organization": "New Mexico Office of Superintendent of Insurance", "use": "Current obesity-drug EHB benefit", "url": "https://www.osi.state.nm.us/wp-content/uploads/nm_bmp.pdf", "source_type": "Primary state source", "last_checked": "2026-08-01" }, { "organization": "North Carolina Department of Insurance", "use": "Current EHB plan's clinical-obesity prescription-drug language", "url": "https://www.ncdoi.gov/documents/life-and-health/healthcare-law/2017-nc-ehb-benchmark-plan-bcbsnc-2017-plan-document/open", "source_type": "Primary state source", "last_checked": "2026-08-01" }, { "organization": "Illinois General Assembly", "use": "State employee injectable medicine mandate", "url": "https://ilga.gov/documents/legislation/ilcs/documents/000503750K6.11C.htm", "source_type": "Primary state law", "last_checked": "2026-08-01" }, { "organization": "Colorado General Assembly", "use": "Future large-group optional anti-obesity drug offer", "url": "https://leg.colorado.gov/laws/session-laws/SB25-048/365/download", "source_type": "Primary state law", "last_checked": "2026-08-01" }, { "organization": "Louisiana Legislature", "use": "Act 898 Medicaid requirement and appropriation trigger", "url": "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1481257", "source_type": "Primary state law", "last_checked": "2026-08-01" }, { "organization": "Louisiana Legislature", "use": "Act 749 voluntary OGB plan offer", "url": "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1480474", "source_type": "Primary state law", "last_checked": "2026-08-01" }, { "organization": "Maryland General Assembly", "use": "Chapter 866 Medicaid authorization", "url": "https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0496?ys=2026RS", "source_type": "Primary state law", "last_checked": "2026-08-01" }, { "organization": "Arkansas General Assembly", "use": "Act 628 obesity treatment and drug exclusion", "url": "https://arkleg.state.ar.us/Home/FTPDocument?path=%2FACTS%2F2025R%2FPublic%2FACT628.pdf", "source_type": "Primary state law", "last_checked": "2026-08-01" }, { "organization": "Alaska Division of Insurance", "use": "Final 2026 EHB obesity-drug exclusion", "url": "https://www.commerce.alaska.gov/web/Portals/11/Pub/AK.EHBPlanDocument_2024.pdf", "source_type": "Primary state source", "last_checked": "2026-08-01" }, { "organization": "California Legislative Information", "use": "Current amended SB 1089 text", "url": "https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260SB1089", "source_type": "Primary state bill source", "last_checked": "2026-08-01" }, { "organization": "Florida Senate", "use": "HB 977 status and failure", "url": "https://www.flsenate.gov/Session/Bill/2026/977", "source_type": "Primary state bill source", "last_checked": "2026-08-01" }, { "organization": "Connecticut General Assembly", "use": "GLP-1 state employee plan reporting statute", "url": "https://prdext2.cga.ct.gov/2026/sup/chap_067.htm", "source_type": "Primary state law", "last_checked": "2026-08-01" }, { "organization": "Connecticut Office of the State Comptroller", "use": "Current anti-obesity medication program page", "url": "https://carecompass.ct.gov/pharmacy/weight-loss-medications/", "source_type": "Primary plan administrator", "last_checked": "2026-08-01" }, { "organization": "NCSL", "use": "State policy trend overview and legislative-discovery audit", "url": "https://www.ncsl.org/health/glp-1s-cost-coverage-state-policy-trends", "source_type": "Secondary audit source", "last_checked": "2026-08-01" }, { "organization": "KFF", "use": "Current Medicaid administrative coverage landscape; not a mandate tracker", "url": "https://www.kff.org/medicaid/medicaid-coverage-of-and-spending-on-glp-1s/", "source_type": "Secondary context source", "last_checked": "2026-08-01" }, { "organization": "Agency for Healthcare Research and Quality", "use": "2024 private-sector self-insured enrollment share by state, Table II.B.2.b.(1)", "url": "https://datatools.ahrq.gov/meps-ic/", "source_type": "Primary federal survey source", "last_checked": "2026-08-01" }, { "organization": "Connecticut General Assembly", "use": "Medicaid/CHIP authorization and utilization-management conditions in P.A. 25-168", "url": "https://www.cga.ct.gov/2025/sum/pdf/2025SUM00168-R02HB-07287-SUM.pdf", "source_type": "Primary/official state legislative summary", "last_checked": "2026-08-01" }, { "organization": "Florida Department of Management Services", "use": "2026 annual state group Weight Management Program terms and 2,800-member cap", "url": "https://www.mybenefits.myflorida.com/content/download/438643/file/2026%20Florida%20Benefit%20Guide.pdf", "source_type": "Primary public-plan source", "last_checked": "2026-08-01" } ] }