House Bill No. 5482 mandates that health insurance policies in Connecticut, both individual and group, must provide coverage for a twelve-month supply of prescription hormone therapy and necessary administration supplies, effective January 1, 2027. This requirement applies to policies covering specific medical expenses as outlined in section 38a-469 of the general statutes. Exceptions to this mandate include cases where the insured or prescribing provider requests a smaller supply, or if the hormone therapy is classified as a controlled substance, limiting reimbursement to the maximum refills allowed under state and federal law. Additionally, health plans may restrict refills in the last quarter of the plan year if a twelve-month supply has already been dispensed.

The bill also requires the Commissioner of Social Services to ensure Medicaid coverage for a medically necessary twelve-month supply of prescription hormone therapy and any necessary administration supplies, as well as a twelve-month supply of any FDA-approved contraceptive drug, device, or product, unless a smaller supply is requested by the Medicaid enrollee or their prescribing provider. The bill emphasizes that medically necessary services within the Medicaid program must align with accepted medical practices and be appropriate for the individual's health needs. Notably, the bill introduces new provisions to enhance access to contraceptive methods under Medicaid without any deletions from current law. The Human Services Committee has favorably reported the bill with a vote of 16 in favor and 7 against.