WA SB5353

Health carriers must cover diagnosis and treatment of obesity as a chronic disease for plans issued or renewed on or after January 1, 2026, including intensive behavioral/lifestyle treatment, metabolic and bariatric surgery, and FDA-approved obesity medications.

Coverage criteria for FDA-approved obesity medications cannot be more restrictive than FDA-approved indications, and cost-sharing (deductibles, copayments, coinsurance) must be equal to coverage for other illnesses.

Health carriers and managed care organizations may still apply utilization management for medical necessity determinations, but must do so consistently with how they evaluate other covered conditions.

The Health Care Authority must apply to the federal Centers for Medicare and Medicaid Services by November 1, 2025 for matching federal funds to provide these obesity treatment services through Medicaid.

State employee health plans under chapter 41.05 RCW are also subject to these obesity treatment coverage requirements.