CO SB054

All private insurance plans in Colorado must provide coverage for obesity and pre-diabetes treatment, including intensive behavioral or lifestyle therapy, bariatric surgery, and FDA-approved anti-obesity medications, effective January 1, 2025 for individual and small group plans and January 1, 2026 for large employer plans.

Coverage criteria for FDA-approved anti-obesity medications cannot be more restrictive than FDA-approved indications, and obesity treatment must have the same cost-sharing (copayments, deductibles, coinsurance) as coverage for other illnesses.

Plans may apply standard utilization management and medical necessity reviews to obesity and pre-diabetes treatments using the same criteria applied to other conditions, and the law does not apply to dental, vision, or Medicare supplemental plans.

The Colorado Department of Health Care Policy and Financing must seek federal authorization to provide obesity and pre-diabetes treatment under Medicaid and notify members in writing once authorized; the state must submit a determination to federal authorities regarding whether this benefit requires state funding under federal law.

Implementation depends on federal confirmation that the coverage does not constitute an additional benefit requiring state defrayal under 42 U.S.C. § 18031(d)(3)(B), with a 365-day federal response deadline after which the state may proceed if no response is received.