This bill amends various chapters of the General Laws to establish requirements for prescription hormone therapy coverage by health insurance plans in the state. It defines "prescription hormone therapy" as FDA-approved drugs used to medically suppress, increase, or replace hormones that the body is not producing at intended levels, excluding glucagon-like peptide-1 and its receptor agonists. Beginning on January 1, 2027, all individual or group health insurance contracts that provide coverage for prescription hormone therapy must allow for the dispensing of up to 365 days' worth of medication in a single prescription, unless a smaller supply is requested by the enrollee, instructed by the prescribing provider, or if the prescription hormone therapy is a controlled substance. If the therapy is a controlled substance, the health plan must provide reimbursement for the maximum refill allowed under state and federal law to be obtained at one time by the enrollee.

The bill also states that nothing in this section prohibits a health plan from limiting refills that may be obtained in the last quarter of the plan year if a full year's supply of the prescription hormone therapy has already been dispensed during the plan year. It allows health plans to apply drug utilization management strategies to prescription drugs covered under this section, provided they do not conflict with the new requirements. Furthermore, the bill specifies that these provisions do not apply to certain types of insurance coverage, including hospital confinement indemnity, disability income, accident-only, long-term care, Medicare supplement, limited benefit health, specified disease indemnity, and other limited-benefit policies. Additionally, the Executive Office of Health and Human Services (EOHHS) is tasked with ensuring that Medicaid beneficiaries who are prescribed prescription hormone therapy receive up to 365 days of therapy dispensed as a single prescription, and the Secretary of the EOHHS must apply for any necessary amendments to the state Medicaid plan to implement these changes within 90 days of the effective date of this section.