Representative Scott Rosenzweig, sponsor of House Bill 783, opened the committee hearing by urging lawmakers to require insurers to pay for clinically prescribed glucagon‑like peptide‑1 (GLP‑1) medications for patients at high risk of developing type 2 diabetes.

Rosenzweig said the bill would require coverage before a patient becomes diabetic, targeting ‘‘class 3 obesity’’ — a body mass index of 40 or greater — and serious weight‑related complications. ‘‘Insurers should pay for medically necessary weight loss drugs before a patient becomes diabetic instead of requiring them to become diabetic in order to qualify,’’ Rosenzweig said.

Nut graf: The committee heard competing views on clinical benefits and budgetary impact. Physicians’ groups and some legislators argued the drugs can prevent costly chronic disease and improve quality of life for a narrowly defined population; private insurers and small plans warned the mandate would materially raise premiums and produce large state defrayal costs under Montana’s reimbursement process.

Physicians and advocacy groups told the committee doctors are best positioned to judge medical necessity. Jean Branscum, CEO of the Montana Medical Association, said ‘‘these decisions should be made on standard of care, not based on cost’’ and described the bill’s targeted population as ‘‘narrowly defined.’’

Representative Jane Gillette, a co‑proponent, said the measure is limited to a small share of people with class 3 obesity and that coverage can deliver life‑changing improvements: ‘‘You can actually get out of bed. You can play with your grandkids. You can walk upstairs.’’

Insurance representatives described a very different picture. Drew Cziok, government relations director for Blue Cross Blue Shield of Montana, told the committee the company’s actuaries estimate the benefit as originally drafted would cost roughly $47 million per year across its individual and small‑group products and that the state’s defrayal process would require substantial reimbursement. ‘‘If the cost of benefits go up, then premiums go up with it,’’ Cziok said. He added that many GLP‑1 products are priced far higher in the United States than in other countries and that the drugs are usually taken long term.

Bruce Spencer of Mountain Health Co‑op, which serves about 23,000 Montanans in the individual market, estimated the state reimbursement to that co‑op at about $8 million under the bill as written. Both insurers told the committee that rebate assumptions, the statutory wording of ‘‘medically necessary’’ and the eligible BMI threshold would materially change cost estimates.

Committee questions focused on definitions and fiscal tradeoffs. Several members asked whether narrowing eligibility to BMI 40+ or limiting coverage to a single diagnosis (for example, only class 3 obesity and polycystic ovary syndrome) would substantially reduce the fiscal impact; sponsor and insurer witnesses agreed a tighter definition would lower projected costs. Representative Rosenzweig said he would consider an amendment to replace the bill’s phrase ‘‘medically necessary includes, but is not limited to’’ with a narrower, enumerated definition.

Amy Jenks, administrator for the Department of Administration’s Health Care and Benefits Division, told the committee the state employee plan’s preliminary fiscal note estimated plan costs around $4.9 million before rebate assumptions and that the state share could be roughly $4.5 million without changes. She confirmed the state did not budget for this coverage in the current premium request.

Several legislators also raised clinical questions. Representative Rivas described personal experience with obesity care and asked insurers why certain preventive procedures were not covered; Drew Cziok replied insurers base coverage on benefit design and actuarial cost. Representative Nikolakakis asked whether market competition or new entries might lower prices in coming years; Cziok said price declines are possible but uncertain because drug manufacturers protect products via patents and legal strategies.

Opponents from small‑employer groups and credit unions echoed insurer concerns about premium increases for self‑insured employer plans and the state’s fiscal exposure under defrayal rules.

The sponsor closed by reiterating his intent to limit the bill to the high‑risk population and to work with committee members and the appropriations staff on a revised fiscal note. The committee took no final vote and later set House Bill 783 aside from executive action pending amendment work and a revised fiscal note.

Ending: The hearing highlighted the policy trade‑off at the core of many benefit‑mandate debates: clinical benefit for a narrow but high‑risk group versus measured premium and fiscal impacts across public and private plans. Lawmakers asked for clearer cost estimates and a tighter statutory definition before taking a committee vote.