A 9360: Relates to requiring Medicaid coverage of FDA-approved GLP-1 receptor agonist medications for obesity, metabolic disorders, and autism-related compulsive eating behaviors.

  
  STATE OF NEW YORK ________________________________________________________________________ 9360 2025-2026 Regular Sessions  IN ASSEMBLY December 19, 2025 ___________ Introduced by M. of A. SANTABARBARA -- read once and referred to the Committee on Health AN ACT to amend the social services law, in relation to requiring Medi- caid coverage of FDA-approved GLP-1 receptor agonist medications for obesity, metabolic disorders, and autism-related compulsive eating behaviors The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 2 of section 365-a of the social services law 2 is amended by adding a new paragraph (oo) to read as follows: 3 (oo) (i) Federal food and drug administration approved GLP-1 receptor 4 agonist medications for the following medically indicated purposes: 5 (1) obesity treatment in individuals with a body mass index of thirty 6 or greater, or individuals with a body mass index of twenty-seven or 7 greater with a related comorbidity; 8 (2) metabolic disorders, including prediabetes, type two diabetes and 9 metabolic syndrome; and 10 (3) clinically verified autism-related compulsive eating behaviors 11 with certification from a qualified clinician, which shall include a 12 developmental pediatrician, neurologist, psychiatrist, psychologist, or 13 other licensed provider. 14 (ii) The department of health is authorized to require the following: 15 (1) step therapy protocols for such medications, where clinically 16 appropriate; 17 (2) prior authorization of such medications to ensure medical necessi- 18 ty of such medications; 19 (3) income-based eligibility prioritization for high-need, low-income 20 Medicaid recipients to receive coverage for such medications; and/or 21 (4) documentation requirements for clinician certification in cases of 22 autism-related need for such medications pursuant to clause three of 23 subparagraph (i) of this paragraph. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14216-01-5 
 A. 9360 2 1 (iii) The department of health shall: 2 (1) develop clear rules and clinical criteria for coverage of GLP-1 3 receptor agonist medications within one hundred eighty days of the 4 effective date of this paragraph; 5 (2) streamline prior authorization forms and timelines; 6 (3) evaluate health outcomes and potential Medicaid cost savings 7 related to the coverage of such medications; and 8 (4) submit an annual report to the legislature detailing utilization, 9 costs and measurable health outcomes related to the coverage of such 10 medications. 11 (iv) The provisions of this paragraph shall apply to GLP-1 receptor 12 agonist medications approved by the federal food and drug administration 13 on or before the effective date of this paragraph, and shall also apply 14 to emerging GLP-1 receptor agonist medications as such medications are 15 approved by the federal food and drug administration after the effective 16 date of this paragraph. 17 § 2. This act shall take effect immediately.