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 all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels, excluding glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.

Beginning on January 1, 2027, every individual or group health insurance contract, plan, or policy that provides prescription hormone therapy coverage and is delivered, issued for delivery, or renewed in this state must provide reimbursement for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled substance. If the prescription hormone 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 specifies 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 three hundred sixty-five (365) day supply of the prescription hormone therapy has already been dispensed during the plan year. Health plans may apply drug utilization management strategies to prescription drugs covered under this section, to the extent not otherwise prohibited under this section or state or federal law.

Furthermore, the provisions of this section do not apply to insurance coverage providing benefits for hospital confinement indemnity, disability income, accident only, long-term care, Medicare supplement, limited benefit health, specified disease indemnity, sickness or bodily injury or death by accident or both, and other limited-benefit policies. The act is set to take effect upon passage.