Assembly Bill A9360

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9360
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             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:
 
   Section 1. Subdivision 2 of section 365-a of the social  services  law
 is amended by adding a new paragraph (oo) to read as follows:
   (OO)  (I) FEDERAL FOOD AND DRUG ADMINISTRATION APPROVED GLP-1 RECEPTOR
 AGONIST MEDICATIONS FOR THE FOLLOWING MEDICALLY INDICATED PURPOSES:
   (1) OBESITY TREATMENT IN INDIVIDUALS WITH A BODY MASS INDEX OF  THIRTY
 OR  GREATER,  OR  INDIVIDUALS  WITH A BODY MASS INDEX OF TWENTY-SEVEN OR
 GREATER WITH A RELATED COMORBIDITY;
   (2) METABOLIC DISORDERS, INCLUDING PREDIABETES, TYPE TWO DIABETES  AND
 METABOLIC SYNDROME; AND
   (3)  CLINICALLY  VERIFIED  AUTISM-RELATED  COMPULSIVE EATING BEHAVIORS
 WITH CERTIFICATION FROM A QUALIFIED CLINICIAN,  WHICH  SHALL  INCLUDE  A
 DEVELOPMENTAL  PEDIATRICIAN, NEUROLOGIST, PSYCHIATRIST, PSYCHOLOGIST, OR
 OTHER LICENSED PROVIDER.
   (II) THE DEPARTMENT OF HEALTH IS AUTHORIZED TO REQUIRE THE FOLLOWING:
   (1) STEP THERAPY PROTOCOLS  FOR  SUCH  MEDICATIONS,  WHERE  CLINICALLY
 APPROPRIATE;
   (2) PRIOR AUTHORIZATION OF SUCH MEDICATIONS TO ENSURE MEDICAL NECESSI-
 TY OF SUCH MEDICATIONS;
   (3)  INCOME-BASED ELIGIBILITY PRIORITIZATION FOR HIGH-NEED, LOW-INCOME
 MEDICAID RECIPIENTS TO RECEIVE COVERAGE FOR SUCH MEDICATIONS; AND/OR
   (4) DOCUMENTATION REQUIREMENTS FOR CLINICIAN CERTIFICATION IN CASES OF
 AUTISM-RELATED NEED FOR SUCH MEDICATIONS PURSUANT  TO  CLAUSE  THREE  OF
 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
 
   (III) THE DEPARTMENT OF HEALTH SHALL:
   (1)  DEVELOP  CLEAR  RULES AND CLINICAL CRITERIA FOR COVERAGE OF GLP-1
 RECEPTOR AGONIST MEDICATIONS WITHIN  ONE  HUNDRED  EIGHTY  DAYS  OF  THE
 EFFECTIVE DATE OF THIS PARAGRAPH;
   (2) STREAMLINE PRIOR AUTHORIZATION FORMS AND TIMELINES;
   (3)  EVALUATE  HEALTH  OUTCOMES  AND  POTENTIAL  MEDICAID COST SAVINGS
 RELATED TO THE COVERAGE OF SUCH MEDICATIONS; AND
   (4) SUBMIT AN ANNUAL REPORT TO THE LEGISLATURE DETAILING  UTILIZATION,
 COSTS  AND  MEASURABLE  HEALTH  OUTCOMES RELATED TO THE COVERAGE OF SUCH
 MEDICATIONS.
   (IV) THE PROVISIONS OF THIS PARAGRAPH SHALL APPLY  TO  GLP-1  RECEPTOR
 AGONIST MEDICATIONS APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION
 ON  OR BEFORE THE EFFECTIVE DATE OF THIS PARAGRAPH, AND SHALL ALSO APPLY
 TO EMERGING GLP-1 RECEPTOR AGONIST MEDICATIONS AS SUCH  MEDICATIONS  ARE
 APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION AFTER THE EFFECTIVE
 DATE OF THIS PARAGRAPH.
   § 2. This act shall take effect immediately.