[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3560 Introduced in Senate (IS)]
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119th CONGRESS
1st Session
S. 3560
To amend title XVIII of the Social Security Act to provide coverage of
contraceptive items and services at no cost-sharing under the Medicare
program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 18, 2025
Ms. Hassan (for herself, Ms. Murkowski, Ms. Duckworth, and Ms. Collins)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide coverage of
contraceptive items and services at no cost-sharing under the Medicare
program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Closing the Contraception Coverage
Gap Act''.
SEC. 2. PROVIDING COVERAGE OF CONTRACEPTIVE ITEMS AND SERVICES AT NO
COST-SHARING UNDER THE MEDICARE PROGRAM.
(a) Part B Coverage.--
(1) In general.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) in subparagraph (JJ), by inserting
``and'' after the semicolon at the end; and
(ii) by adding at the end the following new
subparagraph:
``(KK) contraceptive items and services (as defined in
subsection (nnn)) furnished to individuals on or after January
1, 2027;''; and
(B) by adding at the end the following new
subsection:
``(nnn) Contraceptive Items and Services.--
``(1) In general.--The term `contraceptive items and
services' means items and services furnished by a physician or
practitioner (as defined in section 1842(b)(18)(C))--
``(A) that--
``(i) align with guidance as of January 12,
2022, issued in accordance with in section
2713(a)(4) of the Public Health Service Act
(including patient-centered counseling
services); and
``(ii) may be furnished for the purpose of
contraception; or
``(B) that are ancillary clinical services.
``(2) Ancillary clinical services.--For purposes of
paragraph (1)(B), the term `ancillary clinical services'
means--
``(A) clinical services that are related to the
items and services described in paragraph (1)(A),
including consultations, examinations, procedures,
device insertion, ultrasound, pain management, patient
education, referrals, and counseling; and
``(B) follow-up services related to the provision
or use of the items and services described in paragraph
(1)(A), including management of side effects,
counseling for continued adherence, and device removal.
``(3) Clarification.--The term `contraceptive items and
services' includes items and services described in paragraph
(1) regardless of whether such items and services are actually
furnished for purposes of contraception.
``(4) Patient-centered counseling services.--For purposes
of paragraph (1)(A), the Secretary shall issue guidance
regarding the coverage of patient-centered counseling. Such
guidance shall--
``(A) align with guidance as of January 12, 2022,
issued in accordance with section 2713(a)(4) of the
Public Health Service Act.; and
``(B) include the coverage of counseling to all
patients on the full range of contraceptive items and
services described in paragraph (1).''.
(2) Payment.--Section 1833 of the Social Security Act (42
U.S.C. 1395l) is amended--
(A) in subsection (a)(1)--
(i) by striking ``and'' before ``(HH)'';
and
(ii) by inserting the following before the
semicolon: ``and (II) with respect to
contraceptive items and services (as defined in
section 1861(nnn)), the amount paid shall be an
amount equal to 100 percent of the lesser of
the actual charge for the items and services or
the amount determined under a payment basis
determined appropriate by the Secretary''; and
(B) in subsection (b), in the first sentence--
(i) by striking ``, and (13)'' and
inserting ``(13)''; and
(ii) by striking ``1861(n)..'' and
inserting ``1861(n), and (14) such deductible
shall not apply with respect to contraceptive
items and services (as defined in section
1861(nnn)).''.
(3) Exclusion modification.--Section 1862(a)(1) of the
Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
(A) in subparagraph (O), by striking ``and'' at the
end;
(B) in subparagraph (P), by striking the semicolon
and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(Q) in the case of contraceptive items and services (as
defined in section 1861(nnn)), which are not furnished or
ordered by a physician or practitioner (as defined in section
1842(b)(18)(C));''.
(4) Quality measures.--The Secretary of Health and Human
Services may, for the purposes of ensuring quality in services,
develop measures of contraceptive counseling, care, and access,
including but not limited to validated survey instruments.
(b) Part C Cost-Sharing for Contraceptive Items and Services.--
(1) In general.--Section 1852(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395w-22(a)(1)(B)) is amended--
(A) in clause (iv)--
(i) by redesignating subclause (VIII) as
subclause (IX); and
(ii) by inserting after subclause (VII) the
following new subclause:
``(VIII) Contraceptive items and
services (as defined in section
1861(nnn)).''; and
(B) in clause (v), by striking ``and (VI)'' and
inserting ``(VI), and (VIII)''.
(2) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2027.
(c) Part D Coverage and Cost-Sharing for Contraceptive Drugs.--
(1) Coverage.--Section 1860D-4(b)(3)(G) of the Social
Security Act (42 U.S.C. 1395w-104(b)(3)(G)) is amended--
(A) in clause (ii)(I), by adding at the end the
following new sentence: ``Such identification shall
include the drugs described in clause (iv)(VII).''; and
(B) in clause (iv), by adding at the end the
following new subclause:
``(VII) Covered part D drugs
described in guidelines issued pursuant
to section 2713(a)(4) of the Public
Health Service Act and that may be
furnished for purposes of contraception
(regardless of whether such drugs are
actually furnished for purposes of
contraception).''.
(2) Cost-sharing.--Section 1860D-2 of the Social Security
Act (42 U.S.C. 1395w-102) is amended--
(A) in subsection (b)--
(i) in paragraph (1)(A), in the matter
preceding clause (i), by striking ``and (9)''
and inserting ``, (9), and (10)'';
(ii) in paragraph (2)(A), in the matter
preceding clause (i), by striking ``and (9)''
and inserting ``, (9), and (10)''; and
(iii) by adding at the end the following
new paragraph:
``(10) Treatment of cost-sharing for contraceptive drugs.--
For plan years beginning on or after January 1, 2027, with
respect to a covered part D drug that is described in
guidelines issued pursuant to section 2713(a)(4) of the Public
Health Service Act and that may be furnished for purposes of
contraception (regardless of whether such drug is actually
furnished for purposes of contraception)--
``(A) the deductible under paragraph (1) shall not
apply; and
``(B) there shall be no coinsurance or other cost-
sharing under this part with respect to such drug.'';
and
(B) in subsection (c), by adding at the end the
following new paragraph:
``(7) Treatment of cost-sharing for contraceptive drugs.--
The coverage is provided in accordance with subsection
(b)(10).''.
(3) Conforming amendments to cost-sharing for low-income
individuals.--Section 1860D-14(a) of the Social Security Act
(42 U.S.C. 1395w-114(a)) is amended--
(A) in paragraph (1)(D), in each of clauses (ii)
and (iii), by striking ``paragraph (6)'' and inserting
``paragraphs (6) and (7)''; and
(B) by adding at the end the following new
paragraph:
``(7) No application of cost-sharing or deductible for
contraceptive drugs.--For plan years beginning on or after
January 1, 2027, with respect to a covered part D drug that is
described in guidelines issued pursuant to section 2713(a)(4)
of the Public Health Service Act and that is furnished for
purposes of contraception--
``(A) the deductible under section 1860D-2(b)(1)
shall not apply; and
``(B) there shall be no cost-sharing under this
section with respect to such drug.''.
(4) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2027.
(d) Ensuring Comparable Coverage for Dual Eligible Individuals.--In
implementing the amendments made by this section, the Secretary of
Health and Human Services shall ensure that the coverage of
contraceptive items and services (as defined in section 1861(nnn)) of
the Social Security Act (as added by subsection (a)) and covered part D
drugs described in section 1860D-4(b)(3)(G)(VII) of such Act (as added
by subsection (c)(1)) with respect to individuals who are dually
eligible for benefits under the Medicare program under title XVIII of
such Act and for medical assistance under a State plan under title XIX
of such Act (or a waiver of such plan) is at least as comprehensive as
the coverage of such items and services and drugs for such individuals
under such State plans (or waivers of such plans), as determined by the
Secretary based on an annual review of such State plans (and waivers of
such plans).
SEC. 3. HHS STUDY AND REPORT ON PRESCRIPTION DRUG COVERAGE FOR MEDICARE
BENEFICIARIES LIVING WITH DISABILITIES.
(a) Study.--The Secretary of Health and Human Services (in this
section referred to as the ``Secretary'') shall conduct a study on--
(1) the adequacy of access to prescription drug coverage,
including oral contraceptives, among Medicare beneficiaries
living with disabilities who are enrolled under the original
Medicare fee-for-service program under parts A and B of title
XVIII of the Social Security Act (but not enrolled under part C
or D of such title XVIII); and
(2) providing coverage of over-the-counter contraceptive
drugs under the Medicare program under such title XVIII with no
cost-sharing.
(b) Report.--Not later than 1 year after the date of enactment of
this Act, the Secretary shall submit to Congress a report on the study
conducted under subsection (a), together with recommendations for such
legislation and administrative action as the Secretary determines
appropriate.
SEC. 4. GAO STUDY AND REPORT ON CONTRACEPTIVE COVERAGE REQUIREMENTS
UNDER COMMERCIAL AND PUBLIC HEALTH PLANS.
(a) Study.--The Comptroller General of the United States (in this
section referred to as the ``Comptroller General'') shall conduct a
study on the forms of health insurance (including commercial plans and
public health programs (including Medicaid, Medicare, and TRICARE)),
that are not required by State or Federal law to do one or both of the
following:
(1) Cover all forms of contraception approved by the Food
and Drug Administration.
(2) Waive cost-sharing for such contraception.
(b) Report.--Not later than 1 year after the date of enactment of
this Act, the Comptroller General shall submit to Congress a report on
the study conducted under subsection (a), together with recommendations
for such legislation and administrative action as the Comptroller
General determines appropriate.
SEC. 5. GAO STUDY AND REPORT ON DIFFERENCE IN COVERAGE OF CONTRACEPTIVE
ITEMS AND SERVICES FOR DUAL ELIGIBLES.
(a) Study.--The Comptroller General of the United States (in this
section referred to as the ``Comptroller General'') shall conduct a
study on the difference in coverage of contraceptive items and services
for individuals who are dually eligible for Medicare and Medicaid
benefits.
(b) Report.--Not later than 2 years after the date of enactment of
this Act, the Comptroller General shall submit to Congress a report on
the study conducted under subsection (a), together with recommendations
for such legislation and administrative action as the Secretary
determines appropriate.
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