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