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State legislation requiring or restricting employer GLP-1 coverage in 2026. NC, IL, CA, NY trajectory. Self-funded ERISA preemption boundaries.
State legislatures are increasingly active on GLP-1 coverage. North Carolina removed state-employee GLP-1 coverage in 2024 (cost-driven), reversed partially in 2026. California passed AB-2023 requiring weight-loss-indicated GLP-1 coverage in fully-insured commercial plans starting July 2026. Illinois and New York have similar bills pending. ERISA preempts state insurance mandates for self-funded plans, so most large employers remain unaffected — but stop-loss carriers, third-party administrators, and reinsurance are increasingly factoring state trends. Track legislative trajectory by state for fully-insured book.
Editorial summary, not actuarial or legal advice. Plan-design decisions should involve ERISA counsel, actuaries, and PBM partners. Statistics reflect 2025-2026 commercial plan data; member-specific outcomes vary.