Enact Menopause, Perimenopause, and Hormone Therapy Coverage Act

As Introduced

136th
General Assembly

Regular
Session
H. B. No. 767

2025-2026

Representatives Bryant Bailey, Somani

Cosponsors: Representatives McNally,
Brent, Piccolantonio, Miller, J., Abdullahi, Russo, Brennan, Lett,
Tims, Synenberg, Upchurch, Cockley, Sims, White, E., Rader, Brewer,
Brownlee, Lawson-Rowe, Jarrells

To
enact sections 3902.65 and 5164.081 of the Revised Code
to
require insurance and Medicaid coverage of the diagnosis and
treatment of menopause, perimenopause, and menopausal and
perimenopausal symptoms and to name this act the Ohio Menopause,
Perimenopause, and Hormone Therapy Coverage Act.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
sections 3902.65 and 5164.081 of the Revised Code be enacted to read
as follows:

Sec.
3902.65.
(A)
As used in this section:

(1)
"Prescriber" means the following:

(a)
A physician authorized under Chapter 4731. of the Revised Code to
practice medicine and surgery or osteopathic medicine and surgery;

(b)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner who holds a current, valid license issued under
Chapter 4723. of the Revised Code to practice nursing as an advanced
practice registered nurse;

(c)
A physician assistant who holds a license to practice as a physician
assistant issued under Chapter 4730. of the Revised Code, holds a
valid prescriber number issued by the state medical board, and has
been granted physician-delegated prescriptive authority.

(2)
"Menopausal and perimenopausal symptoms" include vasomotor
symptoms, sleep disruption, mood changes, cognitive changes, fatigue,
and related symptoms clinically recognized as related to menopause
and perimenopause.

(B)
On and after the effective date of this section and notwithstanding
section 3901.71 of the Revised Code, a health benefit plan shall
provide coverage for the following as they relate to the diagnosis
and treatment of menopause, perimenopause, and menopausal and
perimenopausal symptoms:

(1)
Clinical laboratory services, clinical evaluation services,
diagnostic services, and provider visits;

(2)
Menopausal and perimenopausal hormone therapy administered orally,
transdermally, vaginally, or by injection and approved by the United
States food and drug administration;

(3)
Nonhormonal treatments for menopausal and perimenopausal symptoms
approved by the United States food and drug administration;

(4)
Menopausal and perimenopausal hormone therapy and nonhormonal
treatments administered in formulations not approved by the United
States food and drug administration when menopausal and
perimenopausal hormone therapy and nonhormonal treatments approved by
the United States food and drug administration are contraindicated or
ineffective, as determined by a prescriber, without requiring a
patient to first attempt any therapy or treatment administered in a
formulation approved by the United States food and drug
administration.

(C)
A health benefit plan shall not impose a cost-sharing requirement for
coverage required under division (B) of this section that exceeds the
cost-sharing requirements that apply to substantially all medical
benefits under the health benefit plan. This division shall not be
interpreted to prohibit a health benefit plan from applying a
cost-sharing requirement that is consistent with cost-sharing
requirements that apply to substantially all medical benefits under
the health benefit plan.

(D)
A health benefit plan shall not apply utilization management
requirements, including prior authorization or formulary management,
for coverage required under division (B) of this section that are
more restrictive than utilization management requirements that apply
to substantially all medical benefits under the health benefit plan.
This division shall not be interpreted to prohibit a health benefit
plan from applying utilization management requirements that are
consistent with utilization management requirements that apply to
substantially all medical benefits under the health benefit plan.

(E)
A health benefit plan shall not deem the diagnosis or treatment of
menopause, perimenopause, and menopausal and perimenopausal symptoms
to be elective or cosmetic in nature.

(F)
The superintendent of insurance shall adopt rules in accordance with
Chapter 119. of the Revised Code as necessary to carry out the
requirements of this section.

(G)
The general assembly finds that recent product labeling updates by
the United States department of health and human services and the
United States food and drug administration have clarified the safety
profile of menopausal hormone therapy. It is the intent of this act
to align state-regulated health coverage with current federal
guidance and clinical standards for treatment with menopausal hormone
therapy.

Sec.
5164.081.
(A)
As used in this section, "prescriber" and "menopausal
and perimenopausal symptoms" have the same meanings as in
section 3902.65 of the Revised Code.

(B)
The medicaid program shall cover the following as they relate to the
diagnosis and treatment of menopause, perimenopause, and menopausal
and perimenopausal symptoms:

(1)
Clinical laboratory services, clinical evaluation services,
diagnostic services, and provider visits;

(2)
Menopausal and perimenopausal hormone therapy administered orally,
transdermally, vaginally, or by injection and approved by the United
States food and drug administration;

(3)
Nonhormonal treatments for menopausal and perimenopausal symptoms
approved by the United States food and drug administration;

(4)
Menopausal and perimenopausal hormone therapy and nonhormonal
treatments administered in formulations not approved by the United
States food and drug administration when menopausal and
perimenopausal hormone therapy and nonhormonal treatments approved by
the United States food and drug administration are contraindicated or
ineffective, as determined by a prescriber, without requiring a
patient to first attempt any therapy or treatment formulation
approved by the United States food and drug administration.

(C)
The medicaid program shall not deem the diagnosis or treatment of
menopause, perimenopause, and menopausal and perimenopausal symptoms
to be elective or cosmetic in nature.

(D)
The general assembly finds that recent product labeling updates by
the United States department of health and human services and the
United States food and drug administration have clarified the safety
profile of menopausal hormone therapy. It is the intent of this act
to align state Medicaid program coverage with current federal
guidance and clinical standards for treatment with menopausal hormone
therapy.

Section
2.
This
act shall be known as the Ohio Menopause, Perimenopause, and Hormone
Therapy Coverage Act.