SENATE BILL REPORT
SB 5353
As of February 2, 2025
Title: An act relating to the diabetes prevention and obesity treatment act.
Brief Description: Concerning the diabetes prevention and obesity treatment act.
Sponsors: Senators Cleveland, Muzzall, Riccelli, Bateman, Frame, Hasegawa, Krishnadasan, Nobles, Valdez and Wilson, C..
Brief History:
Committee Activity: Health & Long-Term Care: 2/04/25.
Brief Summary of Bill
  • Requires health plans, including plans offered to state employees, to provide coverage for the diagnosis and treatment of the chronic disease of obesity, beginning in 2026.
  • Requires Medicaid to provide coverage for the diagnosis and treatment of the chronic disease of obesity upon approval to receive federal match funds for those services.
SENATE COMMITTEE ON HEALTH & LONG-TERM CARE
Staff: Greg Attanasio (786-7410)
Background:

Glucagon-like peptide 1 (GLP-1)  agonists are a class of medication that not only improves blood sugar control but may also lead to weight loss.  The GLP-1 medication mimics the GLP-1 hormone that is released in the gastrointestinal tract in response to eating. One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar. GLP-1 in higher amounts also interacts with the parts of the brain that reduce appetite and signal a feeling of fullness. These medications are used to treat people with Type 2 diabetes or to help those with obesity to lose weight. The types of GLP-1 drugs that have been approved by the U.S. Food and Drug Administration (FDA) for obesity treatment include Saxenda, Wegovy, and Zepbound. Other GLP-1 drugs such as Rybelsus, Ozempic, and Mounjaro are FDA-approved to treat Type 2 diabetes, but not for the weight loss.

 

The American Society for Metabolic and Bariatric Surgery has endorsed several inventions under the category of metabolic and bariatric surgeries. These include a laparoscopic sleeve gastrectomy, gastric bypass, adjustable gastric band, biliopancreatic diversion with duodenal switch, and single anastomosis duodenal-ileal bypass with sleeve gastrectomy. 
Summary of Bill:

Beginning January 1, 2026, health plans, including plans offered to state and school employees, must provide coverage for the diagnosis and treatment of the chronic disease of obesity. This includes, but is not limited to, intensive health behavioral and lifestyle treatment, metabolic and bariatric surgery, and FDA approved obesity medication.  

 

Coverage under this section may not be different or separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, copayment, and coinsurance factors, and benefit year maximums for deductibles, copayment, and coinsurance factors.

 

Carriers may apply utilization management to determine the medical necessity of the interventions covered in this act. 

 

By November 1, 2025, the Health Care Authority (HCA) must apply for authorization from the Centers for Medicare and Medicaid Services to receive matching federal funds for providing coverage for the diagnosis and treatment of the chronic disease of obesity. Upon authorization, HCA and all managed care organizations shall provide coverage for these services, including but not limited to intensive health behavioral and lifestyle treatment, metabolic and bariatric surgery, and FDA approved obesity medication.  

 

HCA and managed care organization may apply utilization management to determine the medical necessity of the interventions covered in this act. 
Appropriation: None.
Fiscal Note: Requested on January 24, 2025.
Creates Committee/Commission/Task Force that includes Legislative members: No.
Effective Date: Ninety days after adjournment of session in which bill is passed.