Greater Access to Fertility Medication.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 572

Short Title: Greater Access to Fertility Medication. (Public)
Sponsors: Senator Murdock (Primary Sponsor).
Referred to: Rules and Operations of the Senate
March 26, 2025
*S572-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO INCREASE A CCESS TO FERTILITY M EDICATION UNDER CERT AIN 2
HEALTH BENEFIT PLANS THAT OFFER FERTILIT Y TREATMENT COVERAGE 3
AND UNDER THE STATE HEALTH PLAN FOR TEAC HERS AND STATE 4
EMPLOYEES. 5
The General Assembly of North Carolina enacts: 6
SECTION 1.(a) Article 3 of Chapter 58 of the General Statutes is amended by adding 7
a new section to read: 8
"§ 58-3-241. Fertility treatment coverage. 9
(a) The following definitions apply in this section: 10
(1) Experimental fertility procedure. – A procedure for which the published 11
medical evidence is not sufficient for the American Society of Reproductive 12
Medicine, its successor organization, or a comparable organization to regard 13
the procedure as an established medical practice. 14
(2) Fertility treatment. – A procedure, healthcare product, medication, or 15
healthcare service intended to achieve pregnancy consistent with the 16
established medical pr actice and professional guidelines published by the 17
American Society of Reproductive Medicine, its successor organization, or a 18
comparable organization. 19
(3) Insurer. – As defined in G.S. 58-3-167. 20
(b) If a h ealth benefit plan offered by an insurer provides coverage for any fertility 21
treatment, then all of the following shall apply: 22
(1) Any limitation on coverage for ovulation medication shall not be different 23
than the limitations imposed on other prescription medications. 24
(2) No annual or lifetime limitations shall apply to the coverage for ovulation 25
medication and ovulation induction cycles for services provided by healthcare 26
providers that participate in the provider network of the health benefit plan. 27
(c) Nothing in this section shall be construed to require coverage for fertility treatment 28
or experimental fertility procedures under a health benefit plan." 29
SECTION 1.(b) This section is effective October 1, 2025, and applies to insurance 30
contracts issued, renewed, or amended on or after that date. 31
SECTION 2. Effective with the January 1, 2026, plan coverage year, the Board of 32
Trustees for the North Carolina State Health Plan for Teachers and State Employees (State Health 33
Plan) shall remove any annual or lifetime limitations on the coverage for ovulation medication 34
and ovulation induction cycles for services offered in-network under the State Health Plan. Any 35
General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 572-First Edition
limitation on coverage for ovulation medication shall not be different than the limitations 1
imposed on other prescription medications. 2
SECTION 3. Effective July 1, 2025, there is appropriated from the General Fund to 3
the Department of State Treasurer the sum of three hundred thousand dollars ($300,000) in 4
recurring funds for the 2025 -2026 fiscal year and the sum of six hundred thousand dollars 5
($600,000) in recurring funds for the 2026 -2027 fiscal year for the increased costs to the State 6
Health Plan as a result of the implementation of Section 2 of this act. 7
SECTION 4. Except as otherwise provided, this act is effective when it becomes 8
law. 9