Today's Law As Amended


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SB-1008 Obesity Treatment Parity Act.(2023-2024)



As Amends the Law Today


SECTION 1.
 This act shall be known, and may be cited, as the Obesity Treatment Parity Act.
SEC. 2.
 The Legislature finds and declares all of the following:
(a) Obesity is a serious chronic disease that is recognized as such by major medical organizations, including the American Medical Association since 2013, the American Association of Clinical Endocrinology, the American College of Cardiology, the Endocrine Society, the American Society for Reproductive Medicine, the Society for Cardiovascular Angiography and Interventions, the American Urological Association, and the American College of Surgeons.
(b) Obesity is a complex chronic disease, one in which genetics, the environment, and biology all play an important factor.
(c) Obesity is linked to more than 200 comorbid conditions.
(d) Obesity is associated with an increased risk of 13 types of cancer.
(e) From 2005 to 2014, most cancers associated with obesity and being overweight increased in the United States, while cancers associated with other factors decreased.
(f) Obesity reduces a patient’s overall survival rate and cancer-specific survival rate, as well as increases the risk of cancer recurrence.
(g) Obesity disproportionately affects communities of color.
(h) Obesity is impacted by socioeconomic status.
(i) Adults suffering from obesity have a 55 percent higher risk of developing depression over their lifetime.
(j) Obesity accounts for 47 percent of the total cost of chronic diseases in the United States.
(k) Obesity is a highly stigmatized disease.
(l) Barriers to accessing obesity treatments include stigma, racism, and discrimination.
(m) The California Code of Regulations currently requires coverage of outpatient prescription drugs for the treatment of obesity, but only when a patient is diagnosed with “morbid obesity,” modernly referred to as “severe obesity.”
(n) Chronic diseases without the stigma, racism, and discrimination of obesity do not require patients to reach the designation of “morbid” to be worthy of treatment options that include outpatient prescription drugs.
(o) The Obesity Treatment Parity Act would address health equity gaps and social determinants of health for Californians by ensuring the full range of treatment options are available to patients, without them having to reach a level of obesity considered “morbid.”

SEC. 3.

 Section 1374.6 is added to the Health and Safety Code, to read:

1374.6.
 (a) An individual or group health care service plan contract that provides coverage for outpatient prescription drug benefits that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for all of the following regarding the treatment of obesity:
(1) Intensive behavioral therapy.
(2) Bariatric surgery.
(3) At least one FDA-approved antiobesity medication.
(b) This section does not prohibit a plan from applying utilization management to determine the medical necessity for treatment of obesity under this section 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.
(c) For purposes of this section, “FDA-approved antiobesity medication” means a medication approved by the United States Food and Drug Administration with an indication for chronic weight management in patients with obesity.
(d) Coverage criteria for FDA-approved antiobesity medications shall not be more restrictive than the FDA-approved indications for those treatments.
(e) This section does not apply to a specialized health care service plan contract that covers only dental or vision benefits or a Medicare supplement contract.

SEC. 4.

 Section 10123.62 is added to the Insurance Code, to read:

10123.62.
 (a) An individual or group health insurance policy that provides coverage for outpatient prescription drug benefits that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for all of the following regarding the treatment of obesity:
(1) Intensive behavioral therapy.
(2) Bariatric surgery.
(3) At least one FDA-approved antiobesity medication.
(b) This section does not prohibit an insurer from applying utilization management to determine the medical necessity for treatment of obesity under this section 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 policy.
(c) For purposes of this section, “FDA-approved antiobesity medication” means a medication approved by the United States Food and Drug Administration with an indication for chronic weight management in patients with obesity.
(d) Coverage criteria for FDA-approved antiobesity medications shall not be more restrictive than the FDA-approved indications for those treatments.
(e) This section does not apply to a specialized health insurance policy that covers only dental or vision benefits or a Medicare supplement policy.
SEC. 5.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.