HCR 8

 Enrolled Copy  H.C.R. 8
1Concurrent Resolution Directing PEHP to Establish
                         the Weight Management and Obesity Pilot Program
                                       2026 GENERAL SESSION
                                            STATE OF UTAH
                                  Chief Sponsor: Stewart E. Barlow
                                    Senate Sponsor: Daniel McCay
2
3  LONG TITLE
4  General Description:
5      This resolution directs the Public Employees' Benefit Insurance Program to establish the
6  Weight Management and Obesity Pilot Program.
7  Highlighted Provisions:
8      This resolution:
9      ▸ recognizes the existing bariatric surgery pilot program within the Public Employees'
10  Benefit Insurance Program (PEHP); and
11      ▸ directs PEHP to establish a new Weight Management and Obesity Pilot Program that
12  combines the bariatric surgery pilot program with an option for GLP-1 coverage.
13  Money Appropriated in this Bill:
14      None
15  Other Special Clauses:
16      None
17
18  Be it resolved by the Legislature of the state of Utah, the Governor concurring therein:
19      WHEREAS, in accordance with Utah Code Section 49-20-201, the state participates in the
20  Public Employees' Benefit Insurance Program (PEHP);
21      WHEREAS, the state has authorized PEHP since 2011 to administer a pilot program for
22  bariatric surgery for the state health insurance plan with an adjusted annual budget of
23  $1,050,000;
24      WHEREAS, a member must, among other things, meet medical criteria of over 40 BMI or
25  over 35 BMI with certain comorbidities, participate in health coaching, and show an aptitude
26  for weight loss over six months to qualify for the bariatric surgery pilot program;
 H.C.R. 8  Enrolled Copy
27WHEREAS, data suggests that the class of drugs known as glucagon-like peptide-1
28   receptor agonists, known as GLP-1 drugs, could be an effective option for medically qualified
29   members;
30WHEREAS, PEHP currently provides coverage for GLP-1 drugs for diabetes treatment, but
31   does not cover GLP-1 drugs for obesity treatment; and
32WHEREAS, the state desires to make available an alternative GLP-1 benefit for medically
33   qualified members that would be limited in scope to stay within the adjusted budget of the
34   bariatric surgery pilot program:
35NOW, THEREFORE, BE IT RESOLVED that the Legislature of the state of Utah, the
36   Governor concurring therein, directs the Public Employees' Benefit Insurance Program,
37   beginning with the 2026 plan year, to:
38(1) modify the current bariatric surgery pilot program to be the 'Weight Management and
39   Obesity Pilot Program' and include an alternative GLP-1 treatment pathway;
40(2) define the parameters of the alternative GLP-1 treatment pathway for medically
41   qualified members, including requirements that the program:
42a. be administered on a reimbursement basis;
43b. include 50% member cost sharing;
44c. cap monthly PEHP allowed pharmacy expenses at $300 per member;
45d. limit coverage to a 24-month period; and
46e. align current bariatric surgery pilot program coaching and other participation
47   requirements to also apply to the alternative GLP-1 treatment pathway;
48(3) permit medically qualified members who enter the Weight Management and Obesity
49   Pilot Program to make a one-time choice between bariatric surgery and the alternative GLP-1
50   treatment pathway, providing that if a member discontinues use of GLP-1 treatment within six
51   months, the member may participate in the pilot program for bariatric surgery;
52(4) administer the Weight Management and Obesity Pilot Program to stay within the
53   adjusted annual budget; and
54(5) before December 1, 2026, and each year thereafter until 2028, report to the Health and
55   Human Services Interim Committee on the results of the Weight Management and Obesity
56   Pilot Program.
57BE IT FURTHER RESOLVED that a copy of this resolution be sent to the Public
58   Employees' Benefit and Insurance Program.
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