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House of Representatives
HB5482 / File No. 427 1
General Assembly File No. 427
February Session, 2026 House Bill No. 5482
House of Representatives, April 7, 2026
The Committee on Human Services reported through REP.
GILCHREST of the 18th Dist., Chairperson of the Committee on
the part of the House, that the bill ought to pass.
AN ACT CONCERNING TWELVE-MONTH COVERAGE FOR
CONTRACEPTION AND HORMONE THERAPY.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective January 1, 2027) (a) As used in this section, 1
"prescription hormone therapy" means all drugs approved by the 2
United States Food and Drug Administration that are used to medically 3
suppress, increase or replace hormones that the body is not producing 4
at intended levels, as determined by the prescribing provider. 5
"Prescription hormone therapy" does not include glucagon-like peptide-6
1 and glucagon-like peptide-1 receptor agonists. 7
(b) Each individual and group health insurance policy providing 8
coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) 9
of section 38a-469 of the general statutes, delivered, issued for delivery, 10
renewed, amended or continued in this state on or after January 1, 2027, 11
that includes coverage for prescription hormone therapy shall provide 12
reimbursement for a twelve -month supply of covered prescription 13
hormone therapy and any necessary supplies for administration 14
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dispensed at one time, unless the (1) insured requests a smaller supply, 15
(2) prescribing provider instructs that the insured must receive a smaller 16
supply, or (3) prescription hormone therapy is a controlled substance. If 17
the prescription hormone therapy is a controlled substance, the health 18
plan shall provide reimbursement for the maximum refills allowed 19
under state and federal law to be obtained at one time by the insured. 20
(c) Nothing in this section prohibits a health plan from limiting refills 21
that may be obtained in the last quarter of the plan year if a twelve -22
month supply of the prescription hormone therapy has already been 23
dispensed during the plan year. To the extent not otherwise prohibited 24
under state or federal law, health plans may apply drug utilization 25
management strategies to prescription drugs covered under this section. 26
Sec. 2. (NEW) (Effective January 1, 2027) (a) As used in this section, (1) 27
"medically necessary" has the same meaning as provided in section 17b-28
259b of the general statutes; and (2) "prescription hormone therapy" 29
means all drugs approved by the United States Food and Drug 30
Administration that are used to medically suppress, increase or replace 31
hormones that the body is not producing at intended levels, as 32
determined by the prescribing provider. "Prescription hormone 33
therapy" does not include glucagon -like peptide -1 and glucagon -like 34
peptide-1 receptor agonists. 35
(b) The Commissioner of Social Services, to the extent permissible 36
under federal law, shall provide Medicaid coverage for a medically 37
necessary twelve-month supply of prescription hormone therapy and 38
any necessary supplies for administration dispensed at one time, unless 39
the (1) enrollee requests a smaller supply, (2) prescribing provider 40
instructs that the enrollee must receive a smaller supply, or (3) 41
prescription hormone therapy is a controlled substance. If the 42
prescription hormone therapy is a controlled substance, the 43
commissioner shall provide Medicaid coverage for the maximum refills 44
allowed under state and federal law to be obtained at one time by the 45
Medicaid enrollee. 46
Sec. 3. (NEW) ( Effective January 1, 2027 ) The Commissioner of Social 47
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Services, to the extent permissible under federal law, shall provide 48
Medicaid coverage for a twelve -month supply of any prescribed 49
contraceptive drug, device or product approved by the United States 50
Food and Drug Administration and dispensed at one time, unless the 51
Medicaid enrollee or the enrollee's prescribing health care provider 52
requests less than a twelve -month supply of such contraceptive drug, 53
device or product. 54
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2027 New section
Sec. 2 January 1, 2027 New section
Sec. 3 January 1, 2027 New section
HS Joint Favorable
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The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of
the General Assembly, solely for purposes of information, summarization and explanation and do not
represent the intent of the General Assembly or either chamber thereof for any purpose. In general,
fiscal impacts are based upon a variety of informational sources, including the analyst’s professional
knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final
products do not necessarily reflect an assessment from any specific department.
OFA Fiscal Note
State Impact: None
Municipal Impact: None
Explanation
The bill requires fully -insured plans to cover one-time, 12 -month
dispensing of certain covered prescriptions except in specified
situations, resulting in no fiscal impact to the state.
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OLR Bill Analysis
HB 5482
AN ACT CONCERNING TWELVE -MONTH COVERAGE FOR
CONTRACEPTION AND HORMONE THERAPY.
SUMMARY
This bill sets requirements related to prescription hormone therapy
coverage in private insurance and Medicaid. Prescription hormone
therapy includes all federal Food and Drug Administration ( FDA)-
approved drugs (excluding GLP -1 drugs) used to medically suppress,
increase, or replace hormones that the body is not producing at intended
levels, as determined by the provider. It requires private health insurers
that cover the therapy to reimburse for a 12 -month supply and any
administration-related supplies dispensed at one time , with certain
exceptions.
With certain exceptions, t he bill also requires the Department of
Social Services (DSS) commissioner to provide Medicaid coverage for a
(1) medically necessary 12-month supply of prescription hormone
therapy and any administration -related supplies and (2) 12 -month
supply of any FDA -approved prescription contraception drug, device,
or product.
EFFECTIVE DATE: January 1, 2027
PRIVATE INSURANCE COVERAGE
The bill requires individual and group health insurance companies to
reimburse for a 12 -month supply and any necessary administration
supplies of a covered prescription hormone therapy dispensed at one
time, unless the:
1. insured requests a smaller supply;
2. prescribing provider instructs that the insured must receive a
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smaller supply; or
3. prescription hormone therapy is a controlled substance, in which
case the health plan must reimburse for the maximum refills
allowed for the insured under state and federal law.
The requirement applies to each individual or group health insurer,
health care center (HMO), fraternal benefit societ y, health service
corporation, medical service corporation, or other entity that delivers,
issues, renews, amends, or continues a health insurance policy in the
state on or after January 1, 2027, that covers (1) basic hospital expenses,
(2) basic medical -surgical expenses, (3) major medical expenses, or (4)
hospital or medical services. Because of the federal Employee
Retirement Income Secur ity Act (ERISA), state insurance benefit
mandates do not apply to self-insured benefit plans.
The bill specifies that it does not prohibit a health plan from limiting
refills in the last quarter of the plan year if a 12 -month supply has
already been dispensed in the plan year. To the extent state and federal
law allows, the bill allows plans to apply drug utilization strategies to
prescription hormone therapies.
MEDICAID COVERAGE
Prescription Hormone Therapy
The bill requires the DSS commissioner, to the extent federal law
allows, to provide Medicaid coverage for a medically necessary (see
BACKGROUND) 12 -month supply of prescription hormone therapy
and any necessary supplies to administer it dispensed at one time,
unless the:
1. insured requests a smaller supply;
2. prescribing provider instructs that the insured must receive a
smaller supply; or
3. prescription hormone therapy is a controlled substance, in which
case DSS must reimburse for the maximum refills allowed for the
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insured under state and federal law.
Contraception
The bill requires the DSS commissioner, to the extent federal law
allows, to provide Medicaid coverage for a 12 -month supply of any
prescribed FDA -approved contraception drug, device, or product
dispensed at one time, unless the Medicaid enrollee or the en rollee’s
prescribing health care provider requests a smaller supply.
BACKGROUND
Medically Necessary Services in Medicaid
Under the state’s Medicaid program, medically necessary services are
those health services required to prevent, identify, diagnose, treat,
rehabilitate, or ameliorate a person’s medical condition, including
mental illness or its effects, to attain or maintain the person’s achievable
health and independent functioning (CGS § 17b -259b). Medically
necessary services must also be:
1. consistent with generally accepted medical practice standards;
2. clinically appropriate in terms of type, frequency, timing, site,
extent, and duration and considered effective for the person’s
illness, injury, or disease;
3. not primarily for the person’s or provider’s convenience;
4. not more costly than an alternative service likely to produce
equivalent therapeutic or diagnostic results; and
5. based on an assessment of the person and his or her medical
condition.
COMMITTEE ACTION
Human Services Committee
Joint Favorable
Yea 16 Nay 7 (03/19/2026)