Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of disability and health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for plan contracts and insurance policies, and limits the copayment, coinsurance, deductible, and other cost sharing that may be imposed for specified health care services.

This bill would require an individual or group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2025, to include comprehensive coverage for the treatment of obesity in the same manner as any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximums for deductibles and copayment and coinsurance factors.

Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law prohibits cancellation of an insurance policy, as specified, that has been in effect for 60 days, unless, after the effective date of the policy, certain acts have occurred, including nonpayment of the premium, conviction of the named insured of a crime having as one of its necessary elements an act increasing any hazard insured against, or the discovery of fraud or material misrepresentation.

This bill would make technical, nonsubstantive changes to those provisions.

SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: SB 839

SUBJECT: Obesity Treatment Parity Act

SUMMARY:

1. Requires an individual or group health plan contract or health insurance policy to include comprehensive coverage for the treatment of obesity, including coverage for intensive behavioral therapy, bariatric surgery, and federal Food and Drug Administration (FDA)-approved antiobesity medication. Prohibits coverage criteria for FDA-approved antiobesity medications from being more restrictive than the FDA-approved indications for those treatments, and cost-sharing from being different or separate from other illnesses, conditions, or disorders.
   

Existing law:

1. Establishes the Department of Managed Health Care (DMHC) to regulate health plans under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act); California Department of Insurance (CDI) to regulate health and other insurance; and, the Department of Health Care Services (DHCS) to administer the Medi-Cal program. [HSC §1340, et seq., INS §106, et seq., and WIC §14000, et seq.]
   
2. Establishes, as California's essential health benefits (EHBs) benchmark, the Kaiser Small Group Health Maintenance Organization, existing California mandates (including medically necessary basic health care services), and ten federal Affordable Care Act (ACA) mandated benefits as described below. Requires non-grandfathered individual and small group plan contracts and insurance policies to cover EHBs:
   1. Ambulatory patient services;
   2. Emergency services;
   3. Hospitalization;
   4. Maternity and newborn care;
   5. Mental health and substance use disorder services, including behavioral health treatment;
   6. Prescription drugs;
   7. Rehabilitative and habilitative services and devices;
   8. Laboratory services;
   9. Preventive and wellness services and chronic disease management; and,
   10. Pediatric services, including oral and vision care. [HSC §1367.005 and INS §10112.27]
       
3. Requires all DMHC regulated health plans and CDI regulated large group health insurance policies to cover medically necessary basic health care services, defined as all of the following:
   1. Physician services, including consultation and referral;
   2. Hospital inpatient services and ambulatory care services;
   3. Diagnostic laboratory and therapeutic radiologic services;
   4. Home health services;
   5. Preventive health services;
   6. Emergency health care services, including ambulance and ambulance transport services and out-of-area coverage. Basic health care services includes ambulance and ambulance transport services provided through the 911 emergency response system; and,
   7. Hospice care, as specified. [HSC §1345 and INS §10112.281]
      
4. Requires health plans that provide coverage for prescription drugs to maintain an expeditious process by which the prescribing provider may obtain authorization for a medically necessary nonformulary prescription drug. [HSC §1367.24]
   
5. Allows plans that provide coverage for outpatient prescription drug benefits to exclude drugs prescribed solely for the purposes of losing weight, except when medically necessary for the treatment of morbid obesity. Allows plans to require enrollees who are prescribed drugs for morbid obesity to be enrolled in a comprehensive weight loss program, if covered by the plan, for a reasonable time prior to or concurrent with receiving the prescription drug. [Title 28 CCR §1300.67.24]
   
6. Prohibits a health plan contract or insurance policy that covers prescription drug benefits from limiting or excluding coverage for a drug on the basis that the drug is prescribed for a use that is different from the use for which that drug has been approved for marketing by the FDA, provided that all of the following conditions have been met:
   1. The drug is approved by the FDA;
   2. The drug is prescribed by a participating licensed health care professional for the treatment of a life-threatening condition; or the drug is prescribed by a participating licensed health care professional for the treatment of a chronic and seriously debilitating condition, the drug is medically necessary to treat that condition, and the drug is on the plan formulary. Requires, if the drug is not on the plan formulary, the participating subscriber’s request to be considered pursuant to the expeditious process, as specified;
   3. The drug has been recognized for treatment of that condition by any of the following:
      1. The American Hospital Formulary Service’s Drug Information;
      2. One of the following compendia, if recognized by the federal Centers for Medicare and Medicaid Services as part of an anticancer chemotherapeutic regimen:
         1. The Elsevier Gold Standard’s Clinical Pharmacology;
         2. The National Comprehensive Cancer Network Drug and Biologics Compendium; and,
         3. The Thomson Micromedex DrugDex;
   4. Two articles from major peer reviewed medical journals that present data supporting the proposed Off-label use or uses as generally safe and effective unless there is clear and convincing contradictory evidence presented in a major peer reviewed medical journal. [HSC §1367.21 and INS §10123.195]
7. Defines “chronic and seriously debilitating” as diseases or conditions that require ongoing treatment to maintain remission or prevent deterioration and cause significant long-term morbidity. [HSC §1367.21 and INS §10123.195]
   

This bill:

1. Requires an individual or group health plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 2025 to include comprehensive coverage for the treatment of obesity, including coverage for intensive behavioral therapy (IBT), bariatric surgery, and FDA-approved antiobesity medication.
   
2. Prohibits coverage criteria for FDA-approved antiobesity medications from being more restrictive than the FDA-approved indications for those treatments.
   
3. Prohibits this coverage from being 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 and copayment and coinsurance factors.
   
4. States that this does not prohibit a plan from applying utilization management to determine the medical necessity for treatment of obesity if appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered.
   
5. Defines, “FDA-approved antiobesity medication” as any medication approved by the FDA with an indication for chronic weight management in patients with obesity.
   
6. Exempts a specialized health plan contract or health insurance policy that covers only dental or vision benefits or a Medicare supplement contract.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, today, over 42% of Americans have obesity. Experts predict that half of Americans will have obesity by the end of this decade. Rather than a character flaw or just ‘needing to shed a few pounds,’ obesity is a serious, chronic medical condition with linkages to many of the top causes of death, including heart disease, stroke, diabetes, and cancer. The costs of obesity are high and growing. A recent study found that healthcare costs for people with obesity are about $3,500 higher each year than those with healthy weight. When the indirect costs of obesity are included, the total economic costs of obesity are staggering, estimated at nearly $1.4 trillion. Like other chronic diseases, obesity treatment requires a continuum of care, including primary and specialist care, anti-obesity medications, and surgical interventions. This bill would require health plans in California to include comprehensive coverage for the treatment of obesity, increasing access to these life-altering treatments.
2. Obesity classification. According to the Obesity Medical Association (OMA) the diseases of overweight and obesity are classified into increasing BMI levels that typically have increasingly higher levels of health consequences. The following are levels of obesity based on BMI:
   1. Overweight: BMI 25.0-29.9 kg/m²
   2. Class I Obesity: BMI 30.0-34.9 kg/m²
   3. Class II Obesity: BMI 35.0-39.9 kg/m²
   4. Class III Obesity: BMI ≥ 40.0 kg/m²*

The medical definition of extreme obesity (formerly referred to as morbid obesity), according to the OMA, is a serious health condition that results from an abnormally high body mass that is diagnosed by having a BMI greater than 40 kg/m², a BMI of greater than 35 kg/m² with at least one serious obesity-related condition, or being more than 100 pounds over ideal body weight. Using BMI is problematic as it does not assess for obesity because BMI cannot tell if a person’s weight is due to muscle or excess fat. A very lean person with a lot of muscle may be labeled as having Class III obesity. There are more accurate tools, such as Body Composition analyzers, but these are not widely available. There is a valid argument that using a waist measurement at the level of the umbilicus or navel is a better way of determining the level of unhealthy fat.

OMA indicates that problems with obesity come from the strain of carrying excess weight, and include high blood pressure, congestive heart failure, sleep apnea, shortness of breath, nerve pain, arthritis, back pain, heartburn, leg swelling, varicose veins, and physical disability. Other problems result from disturbances in metabolic function from having dysfunctional fat cells, such as Type 2 Diabetes, high cholesterol, heart disease, fatty liver disease, dementia, increased risk of several cancers, kidney disease, stroke, gout, asthma, erectile dysfunction, infertility, polycystic ovary syndrome, pregnancy complications, and blood clots. Patients with Class III obesity also suffer from discrimination, social bias, depression, anxiety, and low self-esteem.

1. California Health Benefits Review Program (CHBRP) report. AB 1996 (Thomson, Chapter 795, Statutes of 2002) requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. CHBRP was created in response to AB 1996, and reviewed this bill. Key findings include:
   1. Disparities. Obesity rates are lowest among those with the highest incomes and educational attainment. Rates of obesity vary in California by race and ethnicity with Asian adults reporting the lowest rates of obesity (13%) followed by White adults (23.7%), with American Indian/Alaska Native adults (40.4%), Black adults (39.1%), and Latino adults (39.4%) all reporting the highest rates. Finally, adults residing in urban locations reported lower rates of obesity compared to adults residing in rural locations. People of color have higher rates of obesity, in part, because they are more likely to live in neighborhoods with obesogenic food environments (food deserts, scarcity of nutritious foods). Black and Latino adults are also more likely to develop an obesity-related disease such as high blood pressure, heart attack, and stroke (Washington et al., 2023). In addition to there being disparities in obesity rates by race and ethnicity, there are also disparities in access to antiobesity treatments and outcomes. Specifically, it was found that Black and Hispanic adults with obesity were more likely to have financial barriers to accessing GLP-1s compared to White adults (Lu et al., 2022). Furthermore, people of color who have obesity are less likely to be assessed for and diagnosed with obesity and offered treatments for obesity (Washington et al., 2023).
      
   2. Societal impacts. Treatment of obesity-related diseases places a large economic burden on the health care system. In a report by the Milken Institute, researchers estimated that the total economic costs attributed to overweight and obesity in the United States exceeded $1.72 trillion — comprised of $480.7 billion in direct health care costs due to diseases caused by overweight and obesity and an additional $1.24 trillion in indirect costs due to lost productivity in 2016 (Waters and Graf, 2018). Within California, Cawley et al. (2021) estimated the total annual medical expenditure related to adult obesity (i.e., BMI >30). In 2016, the total annual medical care expenditures (i.e., direct costs comprised of public and private health insurance expenditures as well as out-of-pocket costs) due to obesity in California was equal to $5.3 billion (Cawley et al., 2021). Translated into 2023 dollars, the total medical expenditures attributed to obesity in California is equal to $6.8 billion.
      
   3. Prevalence in California among privately insured in 2022.

Source: California Health Benefits Review Program, 2023, analysis of the California Health Interview Survey Data. Analysis limited to respondents with employment-based and privately purchased health insurance.

Note: (a) A proportion of those who have BMIs between 27 and 29.9 would also be eligible for obesity treatments if they have additional comorbidities. This has been estimated to be 13% of the overweight population.

(b) Overweight for children under age 18 is defined as having a BMI between the 85th and 95th percentile while obesity is defined as having a BMI in the 95th percentile or above (NIH, 2022). Estimates for teens (aged 13-17) are presented because the data source did not include information on obesity rates for children aged 0 to 12.

(c) In addition, rates for adults >65 are not presented because the vast majority of that population is enrolled in Medicare and thus not enrolled in health insurance subject to SB 839

• 1. FDA-approved drugs. The two groups of prescription drugs approved by the FDA with an indication for chronic weight management are:
     1. Glucagon-like peptide 1 (GLP-1) receptor agonists, and,
     2. Non–GLP-1s.

FDA-Approved Drugs for Weight Management Relevant to SB 839 (Nov 2023)

Source: California Health Benefits Review Program, 2023; FDA, 2023. Note: (a) Tirzepatide (Zepbound) is a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1

• 1. Coverage impacts and enrollees covered. Nearly three million Californians with obesity are enrolled in health insurance subject to this bill, and additional 500,000 overweight Californians with comorbidities. This is based on adolescents and adults up to age 64 that have BMIs that would categorize them as having obesity, and, overweight Californians with BMI ≥ 27 and ˂30 with comorbidities. In the first year postmandate, 14 million enrollees with health insurance subject to this bill would experience a change in benefit coverage and 124,000 would newly utilize obesity treatments. As a result, these enrollees would experience a 5% to 14% reduction in body weight by and related health improvements, which is supported by evidence that obesity treatments are medically effective. CHBRP indicates that 99.9% of enrollees with coverage that would be subject to this bill already have fully compliant coverage for IBT and bariatric surgery with parity in cost-sharing. Over 10% already have fully compliant coverage for these weight management drugs with parity in cost-sharing, and another 3% have compliant coverage without parity in cost-sharing.
     
  2. Medical effectiveness. While CHBRP included reviews of medical effectiveness of IBT and bariatric surgery, this bill analysis is focusing on the medical effectiveness of weight management drugs, as IBT and bariatric surgery are already widely covered by California health plans and insurers.
     
     1. Summary of findings regarding FDA-approved weight management drugs for adults: There is clear and convincing evidence that both FDA approved GLP-1 and non–GLP-1 drugs (liraglutide, semaglutide, tirzepatide, bupropion/naltrexone, and phentermine/topiramate) for weight loss are effective when used as adjuncts to usual care (which includes standard diet and activity and lifestyle recommendations). Use of these drugs increase the amount of weight lost and percent of body weight lost, and reduces BMI compared to placebo or usual care alone. A recent study by the Institute for Clinical and Economic Review (ICER) concluded that compared to placebo, the weight management drugs demonstrated 4.6% to 13.7% mean greater weight loss. Liraglutide, semaglutide, and tirzepatide also improved blood sugar, blood pressure, and physical function compared to usual care. Comparisons across the drugs as well as direct evidence for three drugs (liraglutide, semaglutide, liraglutide) suggest that semaglutide and phentermine/topiramate achieve greater weight loss than liraglutide and bupropion-naltrexone and that tirzepatide is more effective than semaglutide and liraglutide.
        
     2. Summary of findings regarding FDA-approved weight management drugs for children and adolescents: There is limited evidence that weight management drugs improve weight loss in adolescents. Two randomized controlled trials (RCTs) reported that adolescents who received semaglutide had a greater reduction in mean body weight and BMI than adolescents who received a placebo. One RCT evaluating phentermine/topiramate in adolescents with obesity reported significant weight loss compared to placebo. Two systematic reviews reported mixed results on the effects of orlistat on bodyweight and BMI. For liraglutide, one meta-analysis reported that there was no statistically significant difference in weight loss or reduction in BMI, compared to placebo. Bupropion/naltrexone and tirzepatide are not approved for use in adolescents.
        
     3. When data are available, CHBRP estimates the marginal change in relevant harms associated with interventions affected by the proposed mandate. In the case of this bill, there is evidence to suggest that an increase in the use of obesity treatments could result in harm. Potential harms associated with the use of FDA-approved drugs for weight management include gastrointestinal-related symptoms, including nausea, vomiting, constipation, and diarrhea; paresthesia (i.e., burning or prickling sensation, often occurring in the hands, arms, legs, or feet); dry mouth; insomnia; irritability; anxiety; headache; and increased blood pressure and heart rate. Adverse events may contribute to discontinuation of the drug, which can impact overall medical effectiveness of the treatment. It is unclear if long-term use is associated with more severe and persistent harms.
        
  3. Utilization. There would be no material change in utilization of IBT or bariatric surgery postmandate due to the existing 99.9% compliant benefit coverage at baseline. There is also no evidence that IBT or bariatric surgeries would increase due to the increased use of GLP-1 or non– GLP-1 weight management drugs. There are 2,972,677 enrollees with obesity and 513,625 overweight enrollees with comorbidities in plans subject to this bill. At baseline, only 10,008 enrollees use GLP-1 weight management drugs, while 14,838 use non–GLP-1 weight management drugs. Postmandate, due to the 90 percentage point increase in coverage for GPL-1 and 68 percentage point increase in non–GLP-1 weight management drugs, 105,156 enrollees would be expected to use GPL-1 and 44,057 enrollees would be expected to use non–GLP-1 weight management drugs.
     
  4. Medi-Cal. This bill does not include requirements on Medi-Cal. However, CHBRP indicates that Medi-Cal enrollees already have coverage for drugs with FDA indication for weight management, bariatric surgery, and IBT for weight loss.
     
  5. Impact on cost. As new GLP-1 weight management drugs come to the market at higher unit costs, this bill could result in additional expenditures. However, if this bill is interpreted to require coverage of one drug in each class of medication, perhaps generic GLP-1 alternatives could be covered instead of the higher cost brand-name drugs currently on the market or coming to market, resulting in a shift to drugs with lower unit cost. As mentioned above, long-term weight maintenance could also result in reductions in expensive diseases like diabetes, cardiovascular disease, hypertension, and cancer. While those savings would not materialize in the first two years postmandate, the long-term savings could offset some of the expense. However, given the price of the drug ($14,000+ per year), the savings created through improved health status, weight maintenance, and reduction in cost of treating chronic disease with reduction in obesity (e.g., diabetes medications, insulin, etc.) are unlikely to completely offset the expenditures.
     
  6. Impact on expenditures. This bill would increase total net annual expenditures by $1.27 billion or 0.9% for enrollees with plans and polices regulated by the DMHC and CDI. This is due to a $1.12 billion increase in total health insurance premiums paid by employers and enrollees for newly covered benefits and a $150.9 million increase in enrollee expenses for covered benefits. In the following year, the increase in estimated expenditures would be higher.
     
  7. Expense would increase uninsured. Because the change in average premiums would exceed 1% for several health insurance market segments, CHBRP anticipates a measurable change in the number of uninsured persons due to the enactment of this bill, especially in markets where the enrollee bears the majority of any added premium costs. CHBRP estimates that the increases in premiums would cause more than 10,000 enrollees to lose or drop health insurance. This could lead to an increase in the uninsured of 0.43%, but the majority of newly uninsured would likely come from enrollees in the DMHC-regulated individual market and the DMHC-regulated small-group market where premium increases are more likely to be passed on as enrollee out-of-pocket premium costs rather than absorbed by federally funded tax credits or employer contributions to health insurance coverage.
     

Other market segments may not be as impacted. For example, despite an estimated 1.18% increase in the DMHC-regulated individual market, about 75% of the enrollees are in Covered California plans where tax credits are linked to the 2nd lowest silver premium available in the region, such that enrollees a partially protected from premium increases for new benefit mandates because they also cause the tax credits to increase commensurately. The premium increases in the CDI-regulated and DMHC-regulated California Public Employees' Retirement System (CalPERS) market segments are not above 1%, so CHBRP anticipates that coverage losses would be limited to enrollees in DMHC regulated plans, with a specific focus on individual market plans offered outside of Covered California where tax credits to subsidize the cost are unavailable.

• 1. Essential health benefits. CHBRP does not believe this bill would meet the definition of a state benefit mandate that would exceed EHBs (which would require under the ACA, California to defray the costs).
     

1. ICER. ICER is an independent nonprofit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services. ICER’s reports include evidence-based calculations of prices for new drugs compared to expected long term patient outcomes, and cost growth for the overall health care system. In October of 2022, ICER issued an access and affordability alert for one of the weight management drugs, semaglutide, indicating that the amount of added health care costs may be difficult for the health system to absorb in the short term without displacing other needed services, creating pressure on payers to restrict access, or causing rapid growth in health care insurance costs that would threaten access to high-value care for patients. Final ICER policy recommendations prepared for the New England Comparative Effectiveness Public Advisory Council include recommendations to include coverage of weight loss medications in the Medicare and Medicaid programs. With regard to states, it indicates if narrowing coverage is necessary, coverage can be framed to ensure access to lower cost and generic drugs for individuals with clinical characteristics that have the most to benefit. As an example, the National Health System in England has set a higher threshold for treatment with semaglutide using a BMI of greater than or equal to 35 kg/m² or 27 kg/m² with at least one weight related comorbid condition. There is also a recommendation that U.S. payers should ensure efficient systems to process exceptions based on racial and ethnic groups for whom BMI thresholds do not identify risks for future obesity complications, and that higher thresholds should be developed in conjunction with clinical experts.
   
2. Congressional Budget Office (CBO). An October 5, 2023 CBO blog calling for new research in the area of obesity indicates that at present evidence does not support that there is enough potential savings on cardiac care and other health care to offset federal costs of Medicare coverage for antiobesity medication with increased use of antiobesity medication by people with obesity who are not diabetic. The blog indicates that Medicare coverage of these medications would lead to an overall increase in the deficit over the next ten years but that could change depending on the future prices of these medications and their longer-term effects on the use of other health care services.
   
3. Support. This bill’s sponsor, the Chronic Obesity Prevention and Education Alliance, writes that addressing obesity will save lives, drive down health care costs, and lead to numerous societal benefits, including increased productivity and a better quality of life for millions of Californians, that obesity is the mother of all chronic disease and is associated with more than 200 comorbidities, including diabetes, high blood pressure, heart disease and multiple types of cancer, and, this bill will help address these rampant health issues, while driving down costs within California’s health care system, citing a report by Let’s Get Healthy California (a program within California’s Department of Public Health), that indicated if adult BMI were reduced by 5%, California could save $81.7 billion in obesity-related health care costs by 2030. According to the Neuropathy Action Foundation (NAF) and other proponents, obesity has been recognized as a chronic, pervasive, and relapsing disease by the American Medical Association (AMA) for the last decade. Just this year, several medical organizations, including the AMA, have updated their obesity guidelines and practices to reflect the innovative treatments that we now have available to our patients. Proponents write that the federal Office of Personnel Management began requiring obesity care and treatment, inclusive of pharmacotherapy options, for all federal employees effective January 1, 2023. Proponents also write that California has always been a forward-thinking innovator, and it is time to bring our obesity policies up to that standard. With even small percentages of weight-loss, we see significant benefits in other comorbidities such as Polycystic Ovary Syndrome, cholesterol levels, cardiovascular disease, high blood pressure, and prevention or even remission of Type 2 Diabetes. Slighter greater weight loss, 10% to 15%, can improve even more conditions including quality of life, and depression.

1. Opposition. The California Association of Health Plans, Association of California Life and Health Insurance Companies and America’s Health Insurance Plans raise concerns that this bill mandates plans/insurers cover GLP-1 without any guardrails around the use of these drugs. It is important to note that GLP-1 receptor agonists will likely need to be used long term, potentially for life, for the effects on body weight to persist. Whether there are any long-term side effects and complications with the use of these drugs for weight loss over time is currently unknown. While opponents acknowledge that GLP-1’s have offered some promise with respect to significant reductions in body mass, these drugs also carry some known and potentially significant side effects, which is why it is important to ensure that appropriate clinical guardrails for their usage are in place. Regrettably, with the rising popularity of these drugs, we have seen an increase demand by individuals who do not meet these basic clinical parameters. Without appropriate clinical guardrails in place, it is almost certain that these drugs will be utilized in a manner that is inconsistent with general medical necessity standards. Opponents also raise concerns about potentially significant side effects of these drugs, the premium increases associated with this bill, and its impact on the rate of California’s uninsured population. The California Chamber of Commerce writes when looking at health care cost increases in isolation they seem tolerable, however, this bill must be considered in context. Premiums for employers and enrollees consistently increase year after year due to a number of issues including benefit mandates. The 2022 Kaiser Family Foundation Employer Health Benefits Survey indicated that the average premium for family coverage has increased 20% over the last five years and 43% over the last 10 years. Additionally, annual premiums for employer-sponsored family health coverage reached $22,463 in 2022, with workers on average paying $6,106 toward the cost of their coverage. On average, covered workers contribute 17% of the premium for single coverage and 28% of the premium for family coverage. California should not increase health care coverage costs for employers and employees with another mandate.
   
2. Policy comment. CHBRP’s analysis was based on several assumptions, such as: 1) this bill would not apply to plans and policies that do not have coverage for outpatient prescription drugs; 2) on-formulary coverage with cost-sharing parity is for one GLP-1 and one non-GLP-1 medication, and, 3) this bill would not interfere with the health savings account qualification of a high deductible plan health plan. CHBRP also indicated that the bill could be interpreted to cover other tests, treatments and services to treat obesity that were not reviewed in their report. CHBRP assumed the bill would be implemented consistent with FDA approved indications for weight management medications. The committee may wish to amend this bill to clarify the bill is consistent with these assumptions, and/or to narrow this bill to moderate coverage impacts.

SUPPORT AND OPPOSITION:

Support: Chronic Obesity Prevention & Education Alliance (sponsor)

Alliance for Patient Access

American Medical Women’s Association

California State Coordinating Body for the Association of Diabetes Care &

Education Specialists

California Access Coalition

California Chapter American College of Cardiology

California Chronic Care Coalition

California Life Sciences

Latinx Physicians of California

Neuropathy Action Foundation

One individual

Oppose: Americas Health Insurance Plans

Association of California Life and Health Insurance Companies

California Association of Health Plans

California Chamber of Commerce

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