SB 455 — relative to coverage for GLP-1 medication under the state Medicaid plan.

SB 455-FN - AS INTRODUCEDAMENDED BY THE SENATE 03/05/2026 0836s SESSION 26-2204 05/08 SENATE BILL 455-FN AN ACT relative to health plan coverage offor GLP-1 medications.medication under the state Medicaid plan.

Health and Human Services ───────────────────────────────────────────────────────────────── AMENDED ANALYSIS This bill requiresdirects the department of health plansand human services to coverprovide coverage for GLP-1 medicationsmedication under the state Medicaid plan if such medication is medically necessary for a patient based on certain circumstances.health conditions.

SB 455-FN - AS INTRODUCEDAMENDED BY THE SENATE 03/05/2026 0836s 26-2204 05/08 STATE OF NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty-Six AN ACT relative to health plan coverage offor GLP-1 medications.medication under the state Medicaid plan.

ManagedState CareMedicaid Law;Plan;

Coverage for GLP-1 Medications.Medication.

Amend RSA 420-J167 by inserting after section 6-e3-m the following new section:

420-J:6-f167:3-n CoverageState forMedicaid GLP-1Plan; Medication.

Each health carrier offering a health benefit plan in this state shall provide coverage for GLP-1 medicationsMedication. if:

TheMedical coveredassistance person'sunder BMIthe state Medicaid plan shall include coverage for GLP-1 medication if a health care provider licensed in the state of New Hampshire has determined that such medication is equalmedically tonecessary for the patient and the patient meets one or greatermore thanof 40;the following:

(a) BMI greater than or II.equal to 30 kg/m² (obesity);

Theor covered(b) person's BMI isgreater than or equal to or27 greaterkg/m² thanwith 35,at withleast one orweight-related morecomorbidity, ofincluding: the following co-morbidities:

(a)(1) Type 2 diabetes.

(b)(2) HighHypertension. blood pressure or hypertension.

(c)(3) CoronaryDyslipidemia. artery disease.

(d)(4) SleepObstructive sleep apnea.

(e)(5) HighCardiovascular cholesteroldisease. or hyperlipidemia.

(f)(6) SeverePrediabetes. osteoarthritis.

(7) Metabolic dysfunction associated steatotic liver disease.

II.

The department of health and human services shall submit to CMS any amendment to the state Medicaid plan necessary for implementation no later than January 1, 2027.

LBA 26-2204 11/15/2504/10/2026 SB 455-FN- FISCAL NOTE AS INTRODUCEDAMENDED BY THE SENATE (AMENDMENT #2026-0836s) AN ACT relative to health plan coverage of GLP-1 medications.

EstimatedThis Statebill Impactdoes FY 2026 FY 2027 FY 2028 FY 2029 Indeterminable Indeterminable Indeterminable Increase Increase Increase Revenue $0 (range not (rangeprovide notfunding, (rangenor notdoes providedit byauthorize providednew bypositions. provided by agency) agency) agency) Revenue Fund(s) General Fund Expenditures* $0 $0 $0 $0 Funding Source(s) General Fund Appropriations* $0 $0 $0 $0 Funding Source(s) *Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill Estimated Political Subdivision Impact FY 2026 FY 2027 FY 2028 FY 2029 County Revenue $0 $0 $0 $0 County Expenditures $0 Indeterminable Indeterminable Indeterminable Local Revenue $0 $0 $0 $0 Local Expenditures $0 Indeterminable Indeterminable Indeterminable METHODOLOGY:

ThisEstimated billState requiresImpact commercialFY health2026 insuranceFY carriers2027 toFY provide2028 coverageFY for2029 glucagon-likeRevenue peptide-1$0 receptor$0 agonist$0 (GLP-1)$0 medicationsRevenue forFund(s) individualsNone with$2 amillion body$4.3 massmillion index$4.7 (BMI)million ofExpenditures* or$0 higher,general orfunds; for those with a BMI of 35 or higher with at least one qualifying comorbidity such as Type 2 diabetes, hypertension, coronary artery disease, sleep apnea, high cholesterol, or severe osteoarthritis.

Thegeneral Insurancefunds; Department notes this bill expands the eligible population for GLP-1 medications beyond the current commercial coverage model, which largely mirrors Medicare’s eligibility criteria.

Expandinggeneral eligibilityfunds; would likely increase total claims for this class of drugs, which may lead to higher overall premiums.

Increased$6.5 premiumsmillion could$14.4 resultmillion in$15.9 highermillion Insurancefederal Premiumfunds Taxfederal revenuefunds federal funds Funding Source(s) General funds, matching federal Medicaid funds Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriation = Authorized funding to thecover state.cost of bill METHODOLOGY:

ToThis estimatebill therequires fiscal impact precisely, the Departmentstate indicatesMedicaid additionalprogram analysisto ofcover NHGLP-1 Comprehensivemedications Healthif Informationdetermined Systemmedically (CHIS)necessary claimsand dataif would be required to model the expandedpatient eligiblemeets population.certain criteria.

BecauseThe bill requires the Department of significantHealth overlapand amongHuman conditionsServices suchto assubmit obesity,any diabetes,necessary hypertension,waiver requests to the federal Centers for Medicare and hyperlipidemia,Medicaid Services by January 1, 2027, which the marginalDepartment increasetakes into eligiblemean participantsthat andcoverage resultingfor premiumsuch impactmedications cannotwill bebegin determined.approximately on that date.

However,The the Department reportsnotes that asutilization of JuneGLP-1 30,drugs 2025, gross expenditures for commonlyweight prescribedloss GLP-1/GIPhas drugssignificantly exceededincreased $650in millionrecent statewideyears. and are projected to surpass $1 billion by the end of plan year 2025.

BasedThe onDepartment potentialassumes inducedthe demandbill will result in an expenditure increase of 10approximately to$8.5 20million percent,in increasedtotal expendituresfunds in the second half of $100FY27 to(of $200which $2 million will be state funds and $6.5 million will be federal funds), $18,700,000 in FY28 ($4.3 million state, $14.4 million federal), and $20.6 million in FY29 ($4.7 million state, $15.9 million federal).These calculations do not include the state share of additional administration margin or premium tax that are possible.included in the managed care contract capitation rates.

The Department is able to provide a range if needed.

The Department of Administrative Services states the bill will have no impact on the State Employee and Retiree Health Benefit Plan, as the RSA amended applies to fully insured commercial health insurance plans and does not apply to self-funded health benefit plans like the State Employee Health Benefit Plan.

Insurance Department andof DepartmentHealth ofand AdministrativeHuman Services