Read the full stored bill text
Page 1 - 132LR0073(03)
STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-FIVE
_____
H.P. 96 - L.D. 163
An Act to Require Health Insurance Coverage for Federally Approved
Nonprescription Oral Hormonal Contraceptives and Nonprescription
Emergency Contraceptives
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24 MRSA §2332-J, sub-§1, as enacted by PL 1999, c. 341, §1 and affected
by §5, is amended to read:
1. Coverage requirements. All individual and group nonprofit hospital and medical
services plan policies and contracts and all nonprofit health care plan policies and contracts
that provide coverage for prescription drugs or outpatient medical services must provide
coverage for all prescription contraceptives, nonprescription oral hormonal contraceptives
and nonprescription emergency contraceptives approved by the federal Food and Drug
Administration or for outpatient contraceptive services, respectively, to the same extent
that coverage is provided for other prescription drugs or outpatient medical services in
accordance with the requirements of this section. For purposes of this section, the term
"outpatient contraceptive services" means consultations, examinations, procedures and
medical services provided on an outpatient basis and related to the use of contraceptive
methods to prevent an unintended pregnancy. This section may not be construed to apply
to prescription drugs or devices that are designed to terminate a pregnancy.
Sec. 2. 24 MRSA §2332-J, sub-§4, as enacted by PL 2021, c. 609, §1, is amended
to read:
4. Coverage of contraceptive supplies. Coverage required under this section must
include coverage for contraceptive supplies in accordance with the following requirements.
For purposes of this section, "contraceptive supplies" means all contraceptive drugs,
devices and products approved by the federal Food and Drug Administration to prevent an
unwanted pregnancy, including nonprescription oral hormonal contraceptives and
nonprescription emergency contraceptives.
A. Coverage must be provided without any deductible, coinsurance, copayment or
other cost-sharing requirement.
APPROVED
JULY 1, 2025
BY GOVERNOR
CHAPTER
445
PUBLIC LAW
Page 2 - 132LR0073(03)
B. If the federal Food and Drug Administration has approved one or more therapeutic
equivalents of a contraceptive supply, an insurer is not required to cover all those
therapeutically equivalent versions in accordance with this subsection, as long as at
least one is covered without any deductible, coinsurance, copayment or other cost-
sharing requirement in accordance with this subsection.
C. Coverage must be provided for the furnishing or dispensing of prescribed
contraceptive supplies and nonprescription oral hormonal contraceptive supplies
intended to last for a 12-month period, which may be furnished or dispensed all at once
or over the course of the 12 months at the discretion of the health care provider for
prescribed contraceptive supplies.
D. A prescription is not required to obtain a nonprescription oral hormonal
contraceptive or nonprescription emergency contraceptive.
E. A nonprofit hospital or medical service organization or nonprofit health care service
organization shall establish mechanisms to ensure that an enrollee who seeks coverage
for a nonprescription oral hormonal contraceptive or nonprescription emergency
contraceptive at a pharmacy has the option to obtain the nonprescription oral hormonal
contraceptive or nonprescription emergency contraceptive at the point of sale without
payment of any cost-sharing amount or to make the purchase at the pharmacy counter
through an out-of-pocket payment at the point of sale and submit a claim for
reimbursement.
F. The superintendent shall monitor compliance with the requirements for coverage of
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and any rules adopted in accordance with subsection 5, including any
complaints or barriers to implementation.
Sec. 3. 24 MRSA §2332-J, sub-§5 is enacted to read:
5. Rules. The superintendent may adopt rules as necessary to implement the
requirements of this section, including rules related to mechanisms to ensure coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and rules regarding notice to enrollees about how to access coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives. Rules adopted pursuant to this subsection are routine technical rules as
described in Title 5, chapter 375, subchapter 2-A.
Sec. 4. 24-A MRSA §2756, sub-§1, as enacted by PL 1999, c. 341, §2 and affected
by §5, is amended to read:
1. Coverage requirements. All individual health policies and contracts, except
accidental injury, specified disease, hospital indemnity, Medicare supplement, disability
income, long-term care and other limited benefit health insurance policies and contracts,
that provide coverage for prescription drugs or outpatient medical services must provide
coverage for all prescription contraceptives, nonprescription oral hormonal contraceptives
and nonprescription emergency contraceptives approved by the federal Food and Drug
Administration or for outpatient contraceptive services, respectively, to the same extent
that coverage is provided for other prescription drugs or outpatient medical services in
accordance with the requirements of this section. For purposes of this section, the term
"outpatient contraceptive services" means consultations, examinations, procedures and
Page 3 - 132LR0073(03)
medical services provided on an outpatient basis and related to the use of contraceptive
methods to prevent an unintended pregnancy. This section may not be construed to apply
to prescription drugs or devices that are designed to terminate a pregnancy.
Sec. 5. 24-A MRSA §2756, sub-§3, as amended by PL 2021, c. 609, §2, is further
amended to read:
3. Coverage of contraceptive supplies. Coverage required under this section must
include coverage for contraceptive supplies in accordance with the following requirements.
For purposes of this section, "contraceptive supplies" means all contraceptive drugs,
devices and products approved by the federal Food and Drug Administration to prevent an
unwanted pregnancy, including nonprescription oral hormonal contraceptives and
nonprescription emergency contraceptives.
A. Coverage must be provided without any deductible, coinsurance, copayment or
other cost-sharing requirement.
B. If the federal Food and Drug Administration has approved one or more therapeutic
equivalents of a contraceptive supply, an insurer is not required to cover all those
therapeutically equivalent versions in accordance with this subsection, as long as at
least one is covered without any deductible, coinsurance, copayment or other cost-
sharing requirement in accordance with this subsection.
D. Coverage must be provided for the furnishing or dispensing of prescribed
contraceptive supplies and nonprescription oral hormonal contraceptive supplies
intended to last for a 12-month period, which may be furnished or dispensed all at once
or over the course of the 12 months at the discretion of the health care provider for
prescribed contraceptive supplies.
E. A prescription is not required to obtain a nonprescription oral hormonal
contraceptive or nonprescription emergency contraceptive.
F. An insurer shall establish mechanisms to ensure that an enrollee who seeks coverage
for a nonprescription oral hormonal contraceptive or nonprescription emergency
contraceptive at a pharmacy has the option to obtain the nonprescription oral hormonal
contraceptive or nonprescription emergency contraceptive at the point of sale without
payment of any cost-sharing amount or to make the purchase at the pharmacy counter
through an out-of-pocket payment at the point of sale and submit a claim for
reimbursement to the insurer.
G. The superintendent shall monitor compliance with the requirements for coverage
of nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and any rules adopted in accordance with subsection 4, including any
complaints or barriers to implementation.
Sec. 6. 24-A MRSA §2756, sub-§4 is enacted to read:
4. Rules. The superintendent may adopt rules as necessary to implement the
requirements of this section, including rules related to mechanisms to ensure coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and rules regarding notice to enrollees about how to access coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
Page 4 - 132LR0073(03)
contraceptives. Rules adopted pursuant to this subsection are routine technical rules as
described in Title 5, chapter 375, subchapter 2-A.
Sec. 7. 24-A MRSA §2847-G, sub-§1, as enacted by PL 1999, c. 341, §3 and
affected by §5, is amended to read:
1. Coverage requirements. All group insurance policies and contracts, except
accidental injury, specified disease, hospital indemnity, Medicare supplement, disability
income, long-term care and other limited benefit health insurance policies and contracts
that provide coverage for prescription drugs or outpatient medical services must provide
coverage for all prescription contraceptives, nonprescription oral hormonal contraceptives
and nonprescription emergency contraceptives approved by the federal Food and Drug
Administration or for outpatient contraceptive services, respectively, to the same extent
that coverage is provided for other prescription drugs or outpatient medical services in
accordance with the requirements of this section. For purposes of this section, the term
"outpatient contraceptive services" means consultations, examinations, procedures and
medical services provided on an outpatient basis and related to the use of contraceptive
methods to prevent an unintended pregnancy. This section may not be construed to apply
to prescription drugs or devices that are designed to terminate a pregnancy.
Sec. 8. 24-A MRSA §2847-G, sub-§4, as amended by PL 2021, c. 609, §3, is
further amended to read:
4. Coverage of contraceptive supplies. Coverage required under this section must
include coverage for contraceptive supplies in accordance with the following requirements.
For purposes of this section, "contraceptive supplies" means all contraceptive drugs,
devices and products approved by the federal Food and Drug Administration to prevent an
unwanted pregnancy, including nonprescription oral hormonal contraceptives and
nonprescription emergency contraceptives.
A. Coverage must be provided without any deductible, coinsurance, copayment or
other cost-sharing requirement.
B. If the federal Food and Drug Administration has approved one or more therapeutic
equivalents of a contraceptive supply, an insurer is not required to cover all those
therapeutically equivalent versions in accordance with this subsection, as long as at
least one is covered without any deductible, coinsurance, copayment or other cost-
sharing requirement in accordance with this subsection.
D. Coverage must be provided for the furnishing or dispensing of prescribed
contraceptive supplies and nonprescription oral hormonal contraceptive supplies
intended to last for a 12-month period, which may be furnished or dispensed all at once
or over the course of the 12 months at the discretion of the health care provider for
prescribed contraceptive supplies.
E. A prescription is not required to obtain a nonprescription oral hormonal
contraceptive or nonprescription emergency contraceptive.
F. An insurer shall establish mechanisms to ensure that an enrollee who seeks coverage
for a nonprescription oral hormonal contraceptive or nonprescription emergency
contraceptive at a pharmacy has the option to obtain the nonprescription oral hormonal
contraceptive or nonprescription emergency contraceptive at the point of sale without
payment of any cost-sharing amount or to make the purchase at the pharmacy counter
Page 5 - 132LR0073(03)
through an out-of-pocket payment at the point of sale and submit a claim for
reimbursement to the insurer.
G. The superintendent shall monitor compliance with the requirements for coverage
of nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and any rules adopted in accordance with subsection 5, including any
complaints or barriers to implementation.
Sec. 9. 24-A MRSA §2847-G, sub-§5 is enacted to read:
5. Rules. The superintendent may adopt rules as necessary to implement the
requirements of this section, including rules related to mechanisms to ensure coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and rules regarding notice to enrollees about how to access coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives. Rules adopted pursuant to this subsection are routine technical rules as
described in Title 5, chapter 375, subchapter 2-A.
Sec. 10. 24-A MRSA §4247, sub-§1, as reallocated by RR 1999, c. 1, §37, is
amended to read:
1. Coverage requirements. All health maintenance organization individual and
group health contracts that provide coverage for prescription drugs or outpatient medical
services must provide coverage for all prescription contraceptives, nonprescription oral
hormonal contraceptives and nonprescription emergency contraceptives approved by the
federal Food and Drug Administration or for outpatient contraceptive services,
respectively, to the same extent that coverage is provided for other prescription drugs or
outpatient medical services in accordance with the requirements of this section. For
purposes of this section, the term "outpatient contraceptive services" means consultations,
examinations, procedures and medical services provided on an outpatient basis and related
to the use of contraceptive methods to prevent an unintended pregnancy. This section may
not be construed to apply to prescription drugs or devices that are designed to terminate a
pregnancy.
Sec. 11. 24-A MRSA §4247, sub-§4, as amended by PL 2021, c. 609, §4, is further
amended to read:
4. Coverage of contraceptive supplies. Coverage required under this section must
include coverage for contraceptive supplies in accordance with the following requirements.
For purposes of this section, "contraceptive supplies" means all contraceptive drugs,
devices and products approved by the federal Food and Drug Administration to prevent an
unwanted pregnancy, including nonprescription oral hormonal contraceptives and
nonprescription emergency contraceptives.
A. Coverage must be provided without any deductible, coinsurance, copayment or
other cost-sharing requirement.
B. If the federal Food and Drug Administration has approved one or more therapeutic
equivalents of a contraceptive supply, a health maintenance organization is not required
to cover all those therapeutically equivalent versions in accordance with this
subsection, as long as at least one is covered without any deductible, coinsurance,
copayment or other cost-sharing requirement in accordance with this subsection.
Page 6 - 132LR0073(03)
D. Coverage must be provided for the furnishing or dispensing of prescribed
contraceptive supplies and nonprescription oral hormonal contraceptive supplies
intended to last for a 12-month period, which may be furnished or dispensed all at once
or over the course of the 12 months at the discretion of the health care provider for
prescribed contraceptive supplies.
E. A prescription is not required to obtain a nonprescription oral hormonal
contraceptive or nonprescription emergency contraceptive.
F. A health maintenance organization shall establish mechanisms to ensure that an
enrollee who seeks coverage for a nonprescription oral hormonal contraceptive or
nonprescription emergency contraceptive at a pharmacy has the option to obtain the
nonprescription oral hormonal contraceptive or nonprescription emergency
contraceptive at the point of sale without payment of any cost-sharing amount or to
make the purchase at the pharmacy counter through an out-of-pocket payment at the
point of sale and submit a claim for reimbursement to the health maintenance
organization.
G. The superintendent shall monitor compliance with the requirements for coverage
of nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and any rules adopted in accordance with subsection 5, including any
complaints or barriers to implementation.
Sec. 12. 24-A MRSA §4247, sub-§5 is enacted to read:
5. Rules. The superintendent may adopt rules as necessary to implement the
requirements of this section, including rules related to mechanisms to ensure coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives and rules regarding notice to enrollees about how to access coverage for
nonprescription oral hormonal contraceptives and nonprescription emergency
contraceptives. Rules adopted pursuant to this subsection are routine technical rules as
described in Title 5, chapter 375, subchapter 2-A.
Sec. 13. 24-A MRSA §4302, sub-§1, ¶A, as amended by PL 2009, c. 439, Pt. A,
§2, is further amended to read:
A. Coverage provisions, benefits and any exclusions by category of service, type of
provider and, if applicable, by specific service, including but not limited to the
following types of services, exclusions and limitations:
(1) Health care services excluded from coverage;
(2) Health care services requiring copayments or deductibles paid by enrollees;
(3) Restrictions on access to a particular provider type;
(4) Health care services that are or may be provided only by referral; and
(5) Childhood immunizations as recommended by the United States Department
of Health and Human Services, Centers for Disease Control and Prevention and
the American Academy of Pediatrics; and
(6) Coverage requirements for contraceptive supplies, as defined in section 4247,
subsection 4, and the procedures an enrollee must follow to access coverage for
over-the-counter contraceptive supplies and nonprescription contraceptives at a
Page 7 - 132LR0073(03)
pharmacy without an out-of-pocket cost at the point of sale or by submitting a claim
for reimbursement;
Sec. 14. Application. This Act applies to all policies, contracts and certificates
executed, delivered, issued for delivery, continued or renewed in this State on or after
January 1, 2026. For purposes of this Act, all contracts are deemed to be renewed no later
than the next yearly anniversary of the contract date.
Sec. 15. Appropriations and allocations. The following appropriations and
allocations are made.
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF
Departments and Agencies - Statewide 0016
Initiative: Provides funding for the expansion of the requirements in current law for
coverage of contraceptives to include nonprescription oral hormonal contraceptives and
nonprescription emergency contraceptives approved by the federal Food and Drug
Administration. The expanded requirements apply to health plans issued or renewed on or
after January 1, 2026.
GENERAL FUND 2025-26 2026-27
All Other $0 $62,016
__________ __________
GENERAL FUND TOTAL $0 $62,016
HIGHWAY FUND 2025-26 2026-27
All Other $0 $21,571
__________ __________
HIGHWAY FUND TOTAL $0 $21,571