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. contracts.

This bill, the Obesity Treatment Parity Care Access Act, would require an individual or group health care service plan contract or health insurance policy that provides coverage for outpatient prescription drug benefits and is issued, amended, or renewed on or after January 1, 2026, to include coverage for intensive behavioral therapy for the treatment of obesity, bariatric surgery, bariatric surgery and at least one antiobesity medication approved by the United States Food and Drug Administration. 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, 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.

This bill, the Obesity Treatment Parity Act, would require an individual or group health care service plan contract or health insurance policy that provides coverage for outpatient prescription drug benefits and is issued, amended, or renewed on or after January 1, 2026, to include coverage for intensive behavioral therapy for the treatment of obesity, bariatric surgery, and at least one antiobesity medication approved by the United States Food and Drug Administration. 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.

Date of Hearing: August 20, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 535

Author:(Richardson) – As Amended Ver:July 17, 2025

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires a health plan contract include coverage for both bariatric surgery and at least one antiobesity medication.

Specifically, this bill:

1. Requires an individual or group health plan contract that provides coverage for outpatient prescription drugs and is issued, amended, or renewed on or after January 1, 2026, include coverage for both bariatric surgery and at least one U.S. Food and Drug Administration (FDA)-approved medication for the treatment of obesity.
   
2. Clarifies that the bill does not prohibit a health plan from applying utilization management to determine the medical necessity for treatment of obesity if the plan determines appropriateness and medical necessity in the same manner as for the treatment of any other illness, condition, or disorder.
   
3. Prohibits a health plan from applying coverage criteria for FDA-approved antiobesity medications that are more restrictive than the FDA-approved indications for those treatments.
   
4. Defines “FDA-approved antiobesity medication” to mean a medication approved by the FDA with an indication for chronic weight management in patients with obesity.
   
5. Exempts a specialized health plan contract that covers only dental or vision benefits or a Medicare supplement contract.
6. Specifies that the bill does not limit existing prescription drug coverage requirements.
7. Makes findings and declarations regarding obesity as a disease and risk factor for other diseases, and treatment of obesity.

FISCAL EFFECT:

The Department of Managed Health Care (DMHC) estimates costs of approximately $1.47 million in fiscal year (FY) 2026-27, $1.32 million in FY 2027-28, $1.59 million in FY 2028-29, and $1.59 million in FY 2029-30 and annually thereafter (Managed Care Fund). DMHC anticipates this bill will increase workload to assess health plan compliance, address an increase in consumer complaints and independent medical reviews, and address enforcement referrals, among other activities.

COMMENTS:

1. Purpose. This bill is sponsored by the Chronic Obesity Prevention and Education (cHOPE) Alliance, a program of the California Chronic Care Coalition. According to the author:

FDA-approved weight loss medications can be a useful tool in helping people prevent and control diabetes and improve health outcomes by achieving health weight. By including weight loss drugs in combination with a healthy diet and regular exercise we can reduce incidence of diabetes and comorbidities related to obesity and save money in health-related illness.

1. Background. Bariatric surgery is a procedure conducted on the stomach or intestines to induce weight loss. Anti-obesity medications can be broken into two types of drugs: Glucagon-like peptide-1 (GLP-1) receptor agonists and non–GLP-1 medications. GLP-1 medications are a class of drugs that activate the body’s GLP-1 receptors, triggering several downstream effects, including lowering glucose (sugar) levels within the bloodstream, reducing digestion rate, and increasing the sensation of fullness for longer. GLP-1 medications are indicated for type 2 diabetes and obesity, among other conditions. The California Health Benefits Review Program (CHBRP) notes that only three out of eight GLP-1 medications are FDA-approved specifically for the treatment of obesity.
   
   Non–GLP-1 medications treat obesity through a variety of different mechanisms, including blocking fat absorption and deposition, suppressing appetite, and increasing metabolism. There are four non-GLP-1 medications with FDA indications for chronic weight management.
   
   According to CHBRP’s analysis of a prior version of this bill, at baseline, almost all people with health coverage subject to this bill have coverage for bariatric surgery and at least one FDA-approved anti-obesity medication. With this bill, 100% of enrollees would have coverage for these obesity treatments. Coverage for at least one FDA- approved GLP-1 receptor agonist anti-obesity is much less common: 17.4% of enrollees and insureds, including those with Department of Insurance–regulated health insurance (which is not included in this bill as amended), have such coverage. CHBRP expects this bill would result in 100% of enrollees obtaining coverage for a non–GLP-1 medication and that GLP-1 medications would not be fully adopted by plans complying with this bill.
   
   CHBRP found very strong evidence that bariatric surgery is effective in reducing weight in adults, some evidence bariatric surgery is effective in adolescents and children. CHBRP also found very strong evidence that FDA-approved anti-obesity medications are effective in reducing weight in adults and conflicting evidence for children and adolescents. CHBRP estimates this bill would result in an increase in utilization of obesity treatments, including an additional four enrollees receiving bariatric surgery and 4,047 enrollees using anti-obesity medications (all non–GLP-1) in 2026. CHBRP estimates these enrollees would experience a 3% to 14% reduction in body weight, and related health improvements.
   
2. Opposition. The California Association of Health Plans and the Association of California Life and Health Insurance Companies oppose this bill, arguing the bill will inadvertently mandate health plans and insurers cover GLP-1s for weight loss when California is actively re-evaluating and, in some instances, eliminating coverage of these very drugs for weight loss due to their enormous cost.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: July 15, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

SBPCA Bill Id:SB 535

Author:(Richardson) – As Introduced Ver:February 20, 2025

SENATE VOTE: 28-3

SUBJECT: Obesity Treatment Parity Act.

SUMMARY: Requires health plans and health insurers that provide coverage for outpatient prescription drug benefits to include coverage intensive behavioral therapy, bariatric surgery, and at least one Food and Drug Administration (FDA)-approved anti-obesity medication. Specifically, this bill:

1. Requires an individual or group health care service plan contract and health insurance policy that provides coverage for outpatient prescription drug benefits and is issued, amended, or renewed on or after January 1, 2026, to include coverage for all of the following for the treatment of obesity:
   1. Intensive behavioral therapy;
   2. Bariatric surgery; and,
   3. At least one FDA-approved anti-obesity medication.
2. Allows a health plan or health insurer to apply utilization management to determine the medical necessity for treatment of obesity under this bill, 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 by a contract or policy.
3. Prohibits coverage criteria for FDA-approved anti-obesity medications from being more restrictive than the FDA-approved indications for those treatments.
4. Defines an “FDA-approved anti-obesity medication” to mean a medication approved by the federal FDA with an indication for chronic weight management in patients with obesity.
5. Exempts from the provisions of this bill a specialized health care service plan contract or policy that covers only dental or vision benefits or a Medicare supplement contract or policy.
6. Makes legislative findings and declarations regarding obesity as a serious chronic disease, its linkage to chronic health conditions, its cost and coverage impacts, and the stigma associated with the disease.

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) and the California Department of Insurance (CDI) to regulate health insurers under the Insurance Code. [Health and Safety Code (HSC) § 1340, et seq. and Insurance Code (INS) § 106, 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 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]
4. Allows health 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 health 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, California Code of Regulations (CCR) § 1300.67.24]
5. Requires a health insurance policy that covers outpatient prescription drugs to cover medically necessary drugs. [INS § 10123.201]
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:
   4. The American Hospital Formulary Service’s Drug Information;
   5. 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; and,
   6. 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]

FISCAL EFFECT: According to the Senate Appropriations Committee:

1. DMHC estimates costs to be approximately $3,710,000 in 2025-26, $9,848,000 in 2026-27, and $8,988,000 in 2027-28 and annually thereafter for state administration (Managed Care Fund).
2. Unknown costs, likely minor, for CDI for state administration (Insurance Fund).

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, obesity and diabetes are serious problems in the United States. More than 1 in 4 adults in California are obese, increasing from 19.3% in 2001 to 28.2% in 2021. Approximately 11.7% of adults in California have Type 2 diabetes. According to Let’s Get Healthy California, if adult BMI were reduced by 5%, California could save $81.7 billion in obesity related health care costs by 2030. While diet and exercise are critical components of weight loss, many adults still fail to achieve weigh loss on their own. The United States Preventative Task Force has included weight loss medications as part of their research for future recommendations, stating, “Interventions that combined pharmacotherapy with behavioral interventions reported greater weight loss and weight loss maintenance over 12 to 18 months compared with behavioral interventions alone.” FDA approved weight loss medications can be a useful tool in helping people prevent and control diabetes and improve health outcomes by achieving health weight. By including weight loss drugs in combination with a healthy diet and regular exercise, the author concludes we can reduce incidence of diabetes and comorbidities related to obesity and save money on health-related illness.
2. 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. Obesity and treatments. According to CHBRP, obesity is a chronic health condition characterized by an increase in the size and amount of fat cells in the body. Health care providers screen for obesity by calculating patients’ body mass index (BMI), which takes into account an individual height and weight. Risks of heart disease, diabetes, respiratory issues, musculoskeletal disorders, and certain cancers, as well as reduced life expectancy can be increased because of obesity. Causes of obesity are multi-faceted and can include lifestyle habits, environment, stress, health conditions and certain medications, socioeconomic factors, and individual characteristics such as genetics and metabolism. There are several methods used to treat obesity but this bill focuses on intensive behavioral therapy, bariatric surgery, and anti-obesity medications.
   2. Intensive behavioral therapy is a particular form of behavioral intervention that is rigorous, structured, and involves multiple components, and, typically lasts one to two years and provides patients with tools to support weight loss and maintenance of weight loss (e.g., food scales, pedometers).
   3. Bariatric surgery is a procedure conducted on the stomach or intestines to induce weight loss.
   4. Anti-obesity medications can be broken into two types of drugs:
      1. Glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 medications are a class of drugs that activate the body’s GLP-1 receptors. This activation triggers several downstream effects, including lowering glucose (sugar) levels within the bloodstream, reducing digestion rate, and increasing the sensation of fullness for longer. GLP-1 medications are indicated for type 2 diabetes and obesity, among other conditions. CHBRP notes that not all GLP-1 medications are applicable to this bill because only three out of eight are FDA-approved specifically for the treatment of obesity. Those that are relevant include liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound).
      2. Non–GLP-1 medications. Non–GLP-1 medications treat obesity through a variety of different mechanisms, including blocking fat absorption and deposition, suppressing appetite, and increasing metabolism. There are four non-GLP-1 medications with FDA indications for chronic weight management. Bupropion/naltrexone (Contave), Olistat (Xenical, Alli), Phentermine/Topiramate (Qsymie), and Phentermine (c) (Adipex-P, Lomaira).
   5. Coverage impacts and enrollees covered. At baseline, nearly all the population with health insurance subject to this bill has coverage for intensive behavioral therapy (99.8% enrollees), bariatric surgery (99.7% enrollees), and at least one FDA-approved anti-obesity medication. Specifically, 93.2% of enrollees have existing coverage for a non-glucagon-like peptide-1 [non-GLP-1] receptor agonist anti-obesity medication. With this bill, 100% of these enrollees would have coverage for all three obesity treatments. At baseline, 17.4% of enrollees have coverage for at least one FDA- approved GLP-1 receptor agonist anti-obesity. However, it is likely that 100% of enrollees would obtain coverage for a non–GLP-1 medication and that GLP-1 medications would not be fully adopted by plans complying with this bill.
   6. Medical effectiveness. CHBRP found very strong evidence that intensive behavioral health is effective in reducing weight and improving related health outcomes in adults, adolescents, and children. There is very strong evidence that bariatric surgery is effective in reducing weight in adults, and some evidence it is effective in adolescents and children. There is very strong evidence that FDA-approved anti-obesity medications are effective in reducing weight in adults, and conflicting evidence they are effective in reducing weight in children and adolescents.
   7. Utilization. At baseline, CHBRP estimates there are approximately 3.1 million enrollees with obesity and about 756,000 enrollees with overweight and comorbidities. CHBRP estimates zero enrollees utilize intensive behavioral therapy and bariatric surgery without coverage; 42,813 enrollees use GLP-1s without coverage; and 2,023 use non–GLP-1 anti-obesity medications without coverage. In 2026, CHBRP estimates this bill would result in an increase in utilization of obesity treatments, including an additional: 35 enrollees receiving intensive behavioral therapy; four receiving bariatric surgery; and 4,047 utilizing anti-obesity medications (all non–GLP-1). As a result, these enrollees would experience a 3% to 14% reduction in body weight and related health improvements.
   8. Medi-Cal and CalPERS. No impact.
   9. Impact on expenditures. CHBRP estimates this bill would increase total premiums by approximately $530,000 and increase cost-sharing by $98,000 each year. Noncovered expenses for enrollees would be reduced by $219,000.
   10. Long-term impacts. CHBRP estimates approximately 4,086 enrollees would newly use treatments for obesity within one year. Public health impacts would be likely to accrue to these individuals outside of the one-year time frame as they continue to lose and maintain their weight loss. CHBRP found limited evidence to evaluate the long-term benefits of obesity treatments. Therefore, although this limited evidence suggests that there would continue to be a reduction in the overall prevalence of obesity and obesity-related chronic disease, including a reduction in cardiovascular disease, hypertension (i.e., high blood pressure), type 2 diabetes, and certain types of cancer, the magnitude of these benefits is unknown.
   11. Essential health benefits. This bill is unlikely to result in an expansion of EHBs.
3. SUPPORT. This bill is sponsored by the Chronic Obesity Prevention and Education (cHOPE) Alliance, a program of the California Chronic Care Coalition, to ensure access to options for the treatment of obesity. The cHOPE Alliance describes itself as made up of more than fifteen patient advocacy groups and health care provider associations, including the Alliance for Patient Access, American Diabetes Association, California Chronic Care Coalition, California Pharmacists Association, California Access Coalition, among many others, that was formed on the belief that obesity must be addressed holistically, like any other chronic disease, and without shame or stigma. The sponsor states that it knows know 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. The sponsor states obesity has been recognized as a chronic, pervasive, and relapsing disease by the American Medical Association for the last decade, and 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. This bill will help address these rampant health issues, while driving down costs within California’s health care system by helping Californians achieve healthy weight levels. Additionally, the sponsor states it would be remiss to not mention the substantial equity issue at play in the obesity space, citing numerous historically disadvantaged groups by race and income show numbers far higher. The sponsor concludes that, as California strives to address historic wrongs, it must prioritize the health of Californians who have been marginalized by ensuring access to the best that health care innovations have to offer, and this bill will ensure that Californians have a full range of treatment options available for the chronic disease of obesity.
4. OPPOSITION. This bill is opposed by the California Association of Health Plans (CAHP) and the Association of California Life and Health Insurance Companies (ACLHIC) which state that health plans and insurers in California currently offer a comprehensive array of weight management tools and interventions designed to promote sustainable, healthy lifestyle changes that effectively lower the risk for long-term health complications. Specifically, CAHP and ACLHIC state that they are troubled that this bill will inadvertently mandate health plans and insurers cover glucagon-like peptide 1 receptor agonists (GLP-1) for weight loss. CAHP and ACLHIC state this comes at a critical juncture when California is actively re-evaluating and, in some instances, eliminating coverage of these very drugs for weight loss due to their enormous cost. Health care leaders and nonpartisan budget experts across the state are already sounding the alarm about the unsustainable financial burden these drugs represent, especially as California faces unprecedented challenges with rising health care costs. CAHP and ACLHIC states the current pricing of these medications is prohibitively expensive, and argues their cost-effectiveness for broad population-level weight loss, particularly in the context of a state mandate, is highly questionable. CAHP and ACLHIC conclude that mandating coverage for these high-cost drugs would ultimately impact premiums and access to other essential health services, and it urges the Assembly Health Committee to consider the broader implications of this mandate on the affordability and accessibility of health care, stating it believes that a balanced approach, focusing on a range of evidence-based, cost-effective weight management strategies, is in the best interest of patients and the health care system.
5. RELATED LEGISLATION. AB 575 (Arambula) would require an individual or group health plan contract or health insurance policy that provides coverage for outpatient prescription drug benefits to include coverage for at least one FDA-approved glucagon-like peptide-1 receptor agonist and intensive behavioral therapy for the treatment of obesity without prior authorization. AB 575 is pending in the Assembly Health Committee.
6. PREVIOUS LEGISLATION.
   1. SB 1008 (Bradford) of 2024 was substantially similar to this bill. SB 1008 was held in the Senate Appropriations Committee.
   2. SB 839 (Bradford) of 2023 was substantially similar to AB 575, except that SB 839 did not prohibit prior authorization and prohibited cost-sharing from being different or separate from other illnesses, conditions, or disorders. SB 839 was not heard in the Senate Health Committee at the author’s request.
7. AMENDMENTS. Following discussions with the author, this bill will be amended to narrow its provisions. The existing legislative findings and declarations will be re-worded, the provisions affecting health insurers in the Insurance Code will be deleted, the provision requiring coverage in the Knox-Keene Act of intensive outpatient therapy will be deleted, and the requirement for coverage for at least one FDA-approved anti-obesity medication will be clarified so that the requirement in this bill does not limit existing prescription drug coverage requirements, including the requirement in existing DMHC regulation requiring coverage of prescription drugs when medically necessary for the treatment of “morbid obesity.”

REGISTERED SUPPORT / OPPOSITION:

Support

The Chronic Obesity Prevention and Education Alliance (sponsor)

Aids Healthcare Foundation
Alliance for Patient Access
American Diabetes Association
Biocom California
California Access Coalition
California Black Health Network
California Chapter American College of Cardiology
California Chronic Care Coalition
California Life Sciences Association
California Pharmacists Association
California Rheumatology Alliance
Looms for Lupus
Nevada Chronic Care Collaborative
Obesity Action Coalition
The L for Lupus Community Foundation
Western Center on Law & Poverty

Oppose

Association of California Life & Health Insurance Companies
California Association of Health Plans
California Chamber of Commerce

Analysis Prepared by: Scott Bain / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 535

Author: Richardson (D)

Introduced: 2/20/25

Vote: 21

SENATE HEALTH COMMITTEE: 8-0, 4/30/25

AYES: Menjivar, Durazo, Gonzalez, Limón, Padilla, Richardson, Weber Pierson, Wiener

NO VOTE RECORDED: Valladares, Grove, Rubio

SENATE APPROPRIATIONS COMMITTEE: 5-0, 5/23/25

AYES: Caballero, Cabaldon, Grayson, Richardson, Wahab

NO VOTE RECORDED: Seyarto, Dahle

SUBJECT: Obesity Treatment Parity Act

SOURCE: California Chronic Care Coalition

DIGEST:

This bill requires a health plan contract or health insurance policy to cover intensive behavioral therapy, bariatric surgery, and at least one federally approved anti-obesity medication.

ANALYSIS:

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. [Health and Safety Code (HSC) § 1340, et seq., Insurance Code (INS) § 106, et seq., and Welfare and Institutions Code (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 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]
4. 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 California Code of Regulations (CCR) § 1300.67.24]

This bill:

1. Requires an individual or group health plan contract or health insurance policy that provides coverage for outpatient prescription drug benefits issued, amended, or renewed on or after January 1, 2026, to include coverage for the following for the treatment of obesity:
   1. Intensive behavioral therapy;
   2. Bariatric surgery; and,
   3. At least one FDA-approved anti-obesity medication.
2. Allows 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 by a contract or policy.
3. Prohibits coverage criteria for federal Food and Drug Administration (FDA) approved anti-obesity medications from being more restrictive than the FDA-approved indications for those treatments.
4. Defines “FDA-approved anti-obesity medication” to mean a medication approved by the FDA with an indication for chronic weight management in patients with obesity.
5. Exempts a specialized health plan contract or health insurance policy that covers only dental or vision benefits or a Medicare supplement contract.

Comments

Author’s statement. According to the author, obesity and diabetes are serious problems in the United States (U.S.). More than one in four adults in California are obese, increasing from 19.3% in 2001 to 28.2% in 2021. Approximately 11.7% of adults in California have Type 2 diabetes. According to Let’s Get Healthy California, if adult body mass index (BMIs) were reduced by 5%, California could save $81.7 billion in obesity related health care costs by 2030. While diet and exercise are critical components of weight loss, many adults still fail to achieve weigh loss on their own. The U.S. Preventative Task Force has even included weight loss medications as part of their research for future recommendations, stating, “Interventions that combined pharmacotherapy with behavioral interventions reported greater weight loss and weight loss maintenance over 12 to 18 months compared with behavioral interventions alone.” FDA approved weight loss medications can be a useful tool in helping people prevent and control diabetes and improve health outcomes by achieving health weight. By including weight loss drugs in combination with a healthy diet and regular exercise, we can reduce incidence of diabetes and comorbidities related to obesity and save money in health-related illness.

Background

California Health Benefits Review Program (CHBRP) report. Key findings include:

Obesity and treatments. According to CHBRP, obesity is a chronic health condition characterized by an increase in the size and amount of fat cells in the body. Health care providers screen for obesity by calculating patients’ BMI, which takes into account an individual height and weight. Risks of heart disease, diabetes, respiratory issues, musculoskeletal disorders, and certain cancers, as well as reduced life expectancy can be increased because of obesity. Causes of obesity are multi-faceted and can include lifestyle habits, environment, stress, health conditions and certain medications, socioeconomic factors, and individual characteristics such as genetics and metabolism. There are several methods used to treat obesity but this bill focuses on intensive behavioral therapy, bariatric surgery, and anti-obesity medications. Intensive behavioral therapy is a particular form of behavioral intervention that is rigorous, structured, and involves multiple components, and, typically lasts one to two years and provides patients with tools to support weight loss and maintenance of weight loss (e.g., food scales, pedometers). Bariatric surgery is a procedure conducted on the stomach or intestines to induce weight loss. Anti-obesity medications can be broken into two types of drugs:

• Glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 medications are a class of drugs that activate the body’s GLP-1 receptors. This activation triggers several downstream effects, including lowering glucose (sugar) levels within the bloodstream, reducing digestion rate, and increasing the sensation of fullness for longer. GLP-1 medications are indicated for type 2 diabetes, obesity, among other conditions. CHBRP notes that not all GLP-1 medications are applicable to this bill because only three out of eight are FDA-approved specifically for the treatment of obesity. Those that are relevant include liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound).
• Non–GLP-1 medications. Non–GLP-1 medications treat obesity through a variety of different mechanisms, including blocking fat absorption and deposition, suppressing appetite, and increasing metabolism. There are four non-GLP-1 medications with FDA indications for chronic weight management. Bupropion/naltrexone (Contave), Olistat (Xenical, Alli), Phentermine/Topiramate (Qsymie), and Phentermine (c) (Adipex-P, Lomaira).

Coverage impacts and enrollees covered. At baseline, nearly all the population with health insurance subject to this bill has coverage for intensive behavioral therapy (99.8% enrollees), bariatric surgery (99.7% enrollees), and at least one FDA-approved anti-obesity medication. Specifically, 93.2% of enrollees have existing coverage for a non-glucagon-like peptide-1 [non-GLP-1] receptor agonist anti-obesity medication. With this bill, 100% of these enrollees would have coverage for all three obesity treatments. At baseline, 17.4% of enrollees have coverage for at least one FDA- approved GLP-1 receptor agonist anti-obesity. However, it is likely that 100% of enrollees would obtain coverage for a non–GLP-1 medication and that GLP-1 medications would not be fully adopted by plans complying with this bill.

Medical effectiveness. CHBRP found very strong evidence that intensive behavioral health is effective in reducing weight and improving related health outcomes in adults, adolescents, and children. There is very strong evidence that bariatric surgery is effective in reducing weight in adults, and some evidence it is effective in adolescents and children. There is very strong evidence that FDA-approved anti-obesity medications are effective in reducing weight in adults, and conflicting evidence they are effective in reducing weight in children and adolescents.

Utilization. Currently, CHBRP estimates there are approximately 3.1 million enrollees with obesity and about 756,000 enrollees with overweight and comorbidities. CHBRP estimates zero enrollees utilize intensive behavioral therapy and bariatric surgery without coverage; 42,813 enrollees use GLP-1s without coverage; and 2,023 use non–GLP-1 anti-obesity medications without coverage. In 2026, CHBRP estimates this bill would result in an increase in utilization of obesity treatments, including an additional: 35 enrollees receiving intensive behavioral therapy; four receiving bariatric surgery; and 4,047 utilizing anti-obesity medications (all non–GLP-1). As a result, these enrollees would experience a 3% to 14% reduction in body weight and related health improvements.

Medi-Cal and CalPERS. No impact.

Impact on expenditures. CHBRP estimates this bill would increase total premiums by approximately $530,000 and increase cost-sharing by $98,000 each year. Noncovered expenses for enrollees would be reduced by $219,000.

Long-term impacts. CHBRP estimates approximately 4,086 enrollees would newly use treatments for obesity within one year. Public health impacts would be likely to accrue to these individuals outside of the one-year time frame as they continue to lose and maintain their weight loss. CHBRP found limited evidence to evaluate the long-term benefits of obesity treatments. Therefore, although this limited evidence suggests that there would continue to be a reduction in the overall prevalence of obesity and obesity-related chronic disease, including a reduction in cardiovascular disease, hypertension (i.e., high blood pressure), type 2 diabetes, and certain types of cancer, the magnitude of these benefits is unknown.

Essential health benefits. This bill is unlikely to result in an expansion of EHBs.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee,

• DMHC estimates costs to be approximately $3,710,000 in 2025-26, $9,848,000 in 2026-27, and $8,988,000 in 2027-28 and annually thereafter for state administration (Managed Care Fund).
• Unknown costs, likely minor, for CDI for state administration (Insurance Fund).

SUPPORT: (Verified 5/23/25)

California Chronic Care Coalition (source)

Alliance for Patient Access

American Diabetes Association

Biocom California

California Access Coalition

California Black Health Network

California Chapter American College of Cardiology

California Life Sciences Association

California Pharmacists Association

Looms for Lupus

Nevada Chronic Care Collaborative

Obesity Action Coalition

The Chronic Obesity Prevention and Education Alliance

The L for Lupus Community Foundation

Western Center on Law & Poverty

OPPOSITION: (Verified 5/23/25)

Association of California Life & Health Insurance Companies

California Association of Health Plans

California Chamber of Commerce

ARGUMENTS IN SUPPORT: The California Chronic Care Coalition is the sponsor of this bill and writes, “Obesity has been recognized as a chronic, pervasive, and relapsing disease by the American Medical Association (AMA) for the last decade. Just last year, several prominent medical organizations, including the AMA, updated their obesity guidelines and practices to reflect the innovative treatments that are now available for patients. California, which prides itself on being a leading innovator, should ensure that our citizens’ access to obesity care is second to none. This bill will help address these rampant health issues, while driving down costs within California’s health care system. The incredible savings that will be realized through effective obesity management dwarfs the relatively minor initial investment. This bill will ensure that Californians have a full range of treatment options available for the chronic disease of obesity.” Biocom California represents numerous member companies developing innovative treatments and therapies for obesity and its related conditions, and writes, “Our members are at the forefront of discovering breakthrough medications that, when paired with lifestyle modifications, can significantly improve patient outcomes. This bill would ensure that Californians have access to these cutting-edge treatments, allowing our member companies to fulfill their mission of improving public health while driving economic growth in our state's vital life science sector.” Californian Black Health Network writes, “Obesity does not impact all groups equally. According to Let’s Get Healthy California, obesity rates in our state rose from 22.7% in 2009 to 27.1 in 2018. However, numerous historically disadvantaged groups show numbers far higher. For example, 39.8% of African American adults and 33.9% of Hispanic adults have obesity. We also see the highest rates of obesity among individuals in the lowest economic tiers. As California strives to address historic wrongs, we must prioritize the health of Californians who have been marginalized by ensuring access to the best that health care innovations have to offer.”

ARGUMENTS IN OPPOSITION: The California Association of Health Plans and the Association of California Life and Health Insurance Companies write in opposition to 17 health insurance mandate bills including this one. The opposition writes these bills will increase costs, reduce choice and competition and further incent some employers and individuals to avoid state regulation by seeking other coverage options. Benefit mandates impose a one-size-fits all approach to medical care and benefit design without consideration for consumer choice. The opposition strongly urges the Legislature to pause any new mandate bills at this time given the uncertainty regarding what benefits may or may not be covered in the EHB benchmark plan. The opposition also indicates that adding new mandates at a time when the Office of Health Care Affordability (OHCA) is working to curb healthcare costs could disrupt those efforts and make it difficult for health care entities to meet the OCHA spending target. The opposition urges the Legislature to consider the cumulative impacts of these mandates on premiums and access to coverage, and they believe that benefit mandates stifle the use of innovative, evidence-based medicine. 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 2024 Kaiser Family Foundation Employer Health Benefits Survey indicated that the average premium for family coverage has increased 24% over the last five years.”

Prepared by: Teri Boughton / HEALTH / (916) 651-4111

5/26/25 14:14:38

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SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

SB 535 (Richardson) - Obesity Treatment Parity Act

Bill Summary:

SB 535 would require a health plan contract or health insurance policy to provide coverage for the treatment of obesity, as specified.

Fiscal Impact:

• The Department of Managed Health Care (DMHC) estimates costs to be approximately $3,710,000 in 2025-26, $9,848,000 in 2026-27, and $8,988,000 in 2027-28 and annually thereafter for state administration (Managed Care Fund).
• Unknown costs, likely minor, for the California Department of Insurance (CDI) for state administration (Insurance Fund).

Background:

According to the California Health Benefits Review Program (CHBRP):

• Intensive behavioral therapy (IBT) is a particular form of behavioral intervention that is structured and has several components. Patients are provided with tools to support and maintain weight loss (e.g., food scales, pedometers). Existing California law requires coverage for preventive services with an “A” or “B” recommendation from the United States Preventive Services Task Force (USPSTF) without cost sharing or prior authorization for enrollees in health plans and policies. IBT for weight loss has a Grade “B” USPSTF recommendation.
• Bariatric surgery is a procedure conducted on the stomach or intestines to induce weight loss.
• Anti-obesity medications (AOMs) are drugs used for chronic weight management. AOMs can be broken into two types of drugs: glucagon-like peptide-1 (GLP-1) receptor agonists, and non–GLP-1 medications. GLP-1 medications are a class of drugs that activate the body’s GLP-1 receptors. This activation triggers several downstream effects, including lowering glucose (sugar) levels within the bloodstream, reducing digestion rate, and increasing the sensation of fullness for longer. GLP-1 medications are indicated for type 2 diabetes and obesity, among other conditions. Non–GLP-1 AOMs treat obesity through a variety of different mechanisms, including blocking fat absorption and deposition, suppressing appetite, and increasing metabolism.

Proposed Law:

Specific provisions of the bill would:

• Require an individual or group health care service plan contract, or an individual or group health insurance policy that provides coverage for outpatient prescription drug benefits and is issued, amended, or renewed on or after January 1, 2026, to include coverage for all of the following for the treatment of obesity:
  • Intensive behavioral therapy.
  • Bariatric surgery.
  • At least one U.S. Food and Drug Administration (FDA)-approved antiobesity medication.
• Permit a plan/insurer 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 by a contract/policy.
• Define “FDA-approved antiobesity medication” to mean medication approved by the FDA with an indication for chronic weight management in patients with obesity.

Related Legislation:

AB 575 (Arambula) would require an individual or group health plan contract or health insurance policy to include coverage for at least one FDA-approved glucagon-like peptide-1 receptor agonist and intensive behavioral therapy for the treatment of obesity. The bill is currently in the Assembly Health Committee.

SB 1008 (Bradford, 2024) was substantially similar to this bill. SB 1008 was held on the suspense file in this committee.

Staff Comments:

According to the CHBRP analysis of SB 535 (as introduced), CHBRP estimates total annual net expenditures would increase by $410,000, with the majority from increased coverage of non–GLP-1 drugs. This includes an increase in total premiums by approximately $530,000 and increased cost sharing by $98,000, while non-covered expenses for enrollees would be reduced by $219,000.

CHBRP estimates that at baseline, nearly all of the 13.6 million Californians with health insurance subject to SB 535 has coverage for IBT (99.8 percent enrollees), bariatric surgery (99.7 percent enrollees), and at least one FDA-approved AOM. Specifically, 93.2 percent of enrollees have existing coverage for a non-GLP-1 AOM. CHBRP assumed that due to the cost of GLP-1 medications, health plans and policies not yet in compliance with SB 535 at baseline would become compliant by offering a non–GLP-1 medication due to the lower cost.

For enrollees associated with CalPERS in DMHC-regulated plans, premiums would not change. CHBRP also indicates there would be no impact on Medi-Cal expenditures as SB 535 only applies to group and individual health plans and policies.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Caroline Menjivar, Chair

BILL NO: SB 535

SUBJECT: Obesity Treatment Parity Act

SUMMARY:

Requires a health plan contract or health insurance policy to cover intensive behavioral therapy, bariatric surgery, and at least one federally approved anti-obesity medication.

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 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]
4. 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]
5. 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 United States Food and Drug Administration (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:
   4. The American Hospital Formulary Service’s Drug Information;
   5. One of the following compendia, if recognized by the federal Centers for Medicare and Medicaid Services as part of an anticancer chemotherapeutic regimen:
   6. The Elsevier Gold Standard’s Clinical Pharmacology;
   7. The National Comprehensive Cancer Network Drug and Biologics Compendium; and,
   8. The Thomson Micromedex DrugDex; and,
   9. 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]
6. 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 provides coverage for outpatient prescription drug benefits and is issued, amended, or renewed on or after January 1, 2026, to include coverage for the following for the treatment of obesity:
   1. Intensive behavioral therapy;
   2. Bariatric surgery; and,
   3. At least one FDA-approved anti-obesity medication.
      
2. Allows 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 by a contract or policy.
   
3. Prohibits coverage criteria for FDA-approved anti-obesity medications from being more restrictive than the FDA-approved indications for those treatments.
   
4. Defines “FDA-approved anti-obesity medication” to mean a medication approved by the FDA with an indication for chronic weight management in patients with obesity.
   
5. 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, obesity and diabetes are serious problems in the U.S. More than one in four adults in California are obese, increasing from 19.3% in 2001 to 28.2% in 2021. Approximately 11.7% of adults in California have Type 2 diabetes. According to Let’s Get Healthy California, if adult body mass index (BMIs) were reduced by 5%, California could save $81.7 billion in obesity related health care costs by 2030. While diet and exercise are critical components of weight loss, many adults still fail to achieve weigh loss on their own. The U.S. Preventative Task Force has even included weight loss medications as part of their research for future recommendations, stating, “Interventions that combined pharmacotherapy with behavioral interventions reported greater weight loss and weight loss maintenance over 12 to 18 months compared with behavioral interventions alone.” FDA approved weight loss medications can be a useful tool in helping people prevent and control diabetes and improve health outcomes by achieving health weight. By including weight loss drugs in combination with a healthy diet and regular exercise, we can reduce incidence of diabetes and comorbidities related to obesity and save money in health-related illness.
   
2. 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. Obesity and treatments. According to CHBRP, obesity is a chronic health condition characterized by an increase in the size and amount of fat cells in the body. Health care providers screen for obesity by calculating patients’ BMI, which takes into account an individual height and weight. Risks of heart disease, diabetes, respiratory issues, musculoskeletal disorders, and certain cancers, as well as reduced life expectancy can be increased because of obesity. Causes of obesity are multi-faceted and can include lifestyle habits, environment, stress, health conditions and certain medications, socioeconomic factors, and individual characteristics such as genetics and metabolism. There are several methods used to treat obesity but this bill focuses on intensive behavioral therapy, bariatric surgery, and anti-obesity medications.
      1. Intensive behavioral therapy is a particular form of behavioral intervention that is rigorous, structured, and involves multiple components, and, typically lasts one to two years and provides patients with tools to support weight loss and maintenance of weight loss (e.g., food scales, pedometers).
      2. Bariatric surgery is a procedure conducted on the stomach or intestines to induce weight loss.
      3. Anti-obesity medications can be broken into two types of drugs:

Glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 medications are a class of drugs that activate the body’s GLP-1 receptors. This activation triggers several downstream effects, including lowering glucose (sugar) levels within the bloodstream, reducing digestion rate, and increasing the sensation of fullness for longer. GLP-1 medications are indicated for type 2 diabetes, obesity, among other conditions. CHBRP notes that not all GLP-1 medications are applicable to this bill because only three out of eight are FDA-approved specifically for the treatment of obesity. Those that are relevant include liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound).

Non–GLP-1 medications. Non–GLP-1 medications treat obesity through a variety of different mechanisms, including blocking fat absorption and deposition, suppressing appetite, and increasing metabolism. There are four non-GLP-1 medications with FDA indications for chronic weight management. Bupropion/naltrexone (Contave), Olistat (Xenical, Alli), Phentermine/Topiramate (Qsymie), and Phentermine (c) (Adipex-P, Lomaira).

• 1. Coverage impacts and enrollees covered. At baseline, nearly all the population with health insurance subject to this bill has coverage for intensive behavioral therapy (99.8% enrollees), bariatric surgery (99.7% enrollees), and at least one FDA-approved anti-obesity medication. Specifically, 93.2% of enrollees have existing coverage for a non-glucagon-like peptide-1 [non-GLP-1] receptor agonist anti-obesity medication. With this bill, 100% of these enrollees would have coverage for all three obesity treatments. At baseline, 17.4% of enrollees have coverage for at least one FDA- approved GLP-1 receptor agonist anti-obesity. However, it is likely that 100% of enrollees would obtain coverage for a non–GLP-1 medication and that GLP-1 medications would not be fully adopted by plans complying with this bill.
  2. Medical effectiveness. CHBRP found very strong evidence that intensive behavioral health is effective in reducing weight and improving related health outcomes in adults, adolescents, and children. There is very strong evidence that bariatric surgery is effective in reducing weight in adults, and some evidence it is effective in adolescents and children. There is very strong evidence that FDA-approved anti-obesity medications are effective in reducing weight in adults, and conflicting evidence they are effective in reducing weight in children and adolescents.
  3. Utilization. At baseline, CHBRP estimates there are approximately 3.1 million enrollees with obesity and about 756,000 enrollees with overweight and comorbidities. CHBRP estimates zero enrollees utilize intensive behavioral therapy and bariatric surgery without coverage; 42,813 enrollees use GLP-1s without coverage; and 2,023 use non–GLP-1 anti-obesity medications without coverage. In 2026, CHBRP estimates this bill would result in an increase in utilization of obesity treatments, including an additional: 35 enrollees receiving intensive behavioral therapy; four receiving bariatric surgery; and 4,047 utilizing anti-obesity medications (all non–GLP-1). As a result, these enrollees would experience a 3% to 14% reduction in body weight and related health improvements.
  4. Medi-Cal and CalPERS. No impact.
  5. Impact on expenditures. CHBRP estimates this bill would increase total premiums by approximately $530,000 and increase cost-sharing by $98,000 each year. Noncovered expenses for enrollees would be reduced by $219,000.
  6. Long-term impacts. CHBRP estimates approximately 4,086 enrollees would newly use treatments for obesity within one year. Public health impacts would be likely to accrue to these individuals outside of the one-year time frame as they continue to lose and maintain their weight loss. CHBRP found limited evidence to evaluate the long-term benefits of obesity treatments. Therefore, although this limited evidence suggests that there would continue to be a reduction in the overall prevalence of obesity and obesity-related chronic disease, including a reduction in cardiovascular disease, hypertension (i.e., high blood pressure), type 2 diabetes, and certain types of cancer, the magnitude of these benefits is unknown.
  7. Essential health benefits. This bill is unlikely to result in an expansion of EHBs.

1. Related legislation. AB 575 (Arambula) requires an individual or group health plan contract or health insurance policy that provides coverage for outpatient prescription drug benefits issued, amended, or renewed on or after January 1, 2026, to include coverage for at least one FDA-approved glucagon-like peptide-1 receptor agonist and intensive behavioral therapy for the treatment of obesity without prior authorization. AB 575 is set to be heard on April 29, 2025 in the Assembly Health Committee.
   
2. Prior legislation. SB 1008 (Bradford of 2024) was substantially similar to this bill. SB 1008 was held in the Senate Appropriations Committee.
   

SB 839 (Bradford of 2023) was substantially similar to AB 575, except that SB 839 did not prohibit prior authorization and prohibited cost-sharing from being different or separate from other illnesses, conditions, or disorders. SB 839 was not heard in the Senate Health Committee at the author’s request.

1. Support. The California Chronic Care Coalition is the sponsor of this bill and writes obesity has been recognized as a chronic, pervasive, and relapsing disease by the American Medical Association (AMA) for the last decade. Just last year, several prominent medical organizations, including the AMA, updated their obesity guidelines and practices to reflect the innovative treatments that are now available for patients. California, which prides itself on being a leading innovator, should ensure that our citizens’ access to obesity care is second to none. This bill will help address these rampant health issues, while driving down costs within California’s health care system. The incredible savings that will be realized through effective obesity management dwarfs the relatively minor initial investment. This bill will ensure that Californians have a full range of treatment options available for the chronic disease of obesity. Biocom California represents numerous member companies developing innovative treatments and therapies for obesity and its related conditions, and writes, our members are at the forefront of discovering breakthrough medications that, when paired with lifestyle modifications, can significantly improve patient outcomes. This bill would ensure that Californians have access to these cutting-edge treatments, allowing our member companies to fulfill their mission of improving public health while driving economic growth in our state's vital life science sector. Californian Black Health Network writes obesity does not impact all groups equally. According to Let’s Get Healthy California, obesity rates in our state rose from 22.7% in 2009 to 27.1 in 2018. However, numerous historically disadvantaged groups show numbers far higher. For example, 39.8% of African American adults and 33.9% of Hispanic adults have obesity. We also see the highest rates of obesity among individuals in the lowest economic tiers. As California strives to address historic wrongs, we must prioritize the health of Californians who have been marginalized by ensuring access to the best that health care innovations have to offer.
   
2. Opposition. The California Association of Health Plans and the Association of California Life and Health Insurance Companies write in opposition to 17 health insurance mandate bills including this one. The opposition writes these bills will increase costs, reduce choice and competition and further incent some employers and individuals to avoid state regulation by seeking other coverage options. Benefit mandates impose a one-size-fits all approach to medical care and benefit design without consideration for consumer choice. The opposition strongly urges the Legislature to pause any new mandate bills at this time given the uncertainty regarding what benefits may or may not be covered in the EHB benchmark plan. The opposition also indicates that adding new mandates at a time when the Office of Health Care Affordability (OHCA) is working to curb healthcare costs could disrupt those efforts and make it difficult for health care entities to meet the OCHA spending target. The opposition urges the Legislature to consider the cumulative impacts of these mandates on premiums and access to coverage, and they believe that benefit mandates stifle the use of innovative, evidence-based medicine. 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 2024 Kaiser Family Foundation Employer Health Benefits Survey indicated that the average premium for family coverage has increased 24% over the last five years.
   

SUPPORT AND OPPOSITION:

Support: California Chronic Care Coalition (sponsor)

Alliance for Patient Access

American Diabetes Association

Biocom California

California Access Coalition

California Black Health Network

California Chapter American College of Cardiology

California Chronic Care Coalition

California Life Sciences Association

California Pharmacists Association

Looms for Lupus

Nevada Chronic Care Collaborative

Obesity Action Coalition

The Chronic Obesity Prevention and Education Alliance

The L for Lupus Community Foundation

Western Center on Law & Poverty

Oppose: Association of California Life & Health Insurance Companies

California Association of Health Plans

California Chamber of Commerce

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