The bill aims to enhance access to prescription hormone therapy for patients of all ages by mandating that health plans provide reimbursement for a 12-month supply of such therapy when obtained at one time by the enrollee. This requirement will take effect for health plans issued or renewed on or after January 1, 2026. Exceptions to this rule include cases where the enrollee requests a smaller supply, the prescribing provider specifies a smaller amount, or if the therapy is classified as a controlled substance. Additionally, the bill stipulates that health plans must adhere to clinical guidelines for dispensing to ensure patient health while maximizing access to effective hormone therapy.

The bill also includes provisions that allow health plans to limit refills in the last quarter of the plan year if a 12-month supply has already been dispensed, and it permits prescribing providers to temporarily restrict refills to a 90-day supply during acute shortages. Furthermore, health plans may apply drug utilization management strategies to the covered prescription hormone therapies. The bill reenacts and amends RCW 41.05.017 to incorporate these new requirements, specifically referencing the new section added to chapter 48.43 RCW regarding hormone therapy reimbursement.