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PRINTER'S NO. 2252
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1827
Session of
2025
INTRODUCED BY SHUSTERMAN, HANBIDGE, HILL-EVANS, GUENST, SANCHEZ,
HOWARD, RIVERA AND GALLAGHER, AUGUST 27, 2025
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 2, 2025
AN ACT
Providing for medical assistance coverage and insurance coverage
of screening, prevention and treatment measures for
osteoporosis as a result of menopause.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Earlier
Insurance Coverage for Osteoporosis Treatments Act.
Section 2. Legislative findings.
The General Assembly finds that:
(1) Many individuals experiencing menopause have a range
of signs and symptoms, which may include osteoporosis.
(2) Osteoporosis may occur during menopause as a result
of lower estrogen levels in the body.
(3) According to the Cleveland Clinic, throughout the
first five years of menopause, as much as 20% of bone loss
occurs.
(4) Although the average age of women entering menopause
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in the United States is 51 years of age, bone density
screenings are recommended for women over 65 years of age.
(5) Due to the lack of bone density screenings earlier
in life, which would allow for more effective prevention and
treatment measures before osteoporosis is more advanced and
harder to treat, for most women, a bone fracture may be the
first sign of osteoporosis.
(6) Among individuals with osteoporosis, vertebral or
spine fractures, fractures in the forearm or wrist and hip
fractures are the most common.
(7) Bone fractures related to osteoporosis that occur in
the spine or hip areas are especially concerning, as
mortality rates for older adults who have experienced a hip
fracture are significantly higher than those of older adults
who have not experienced a hip fracture.
(8) Bone mineral density testing to measure the amount
of mineral in an individual's bones may be helpful in
screening for and diagnosing osteoporosis.
(9) Osteoporosis medications can be used to slow or stop
the breakdown of bone or assist in the growth of new bone.
(10) Nutritional supplements, increasing exercise and
strength training may also be helpful in reducing the effects
of osteoporosis and alleviating issues with bone density and
muscle pain.
Section 3. Legislative purpose.
The purpose of this act is to provide coverage for
preventative measures, screenings and treatments for
osteoporosis beginning before or at the onset of menopause.
Section 4. Definitions.
The following words and phrases when used in this act shall
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have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Bone mineral density testing." An imaging test that
measures the amount of mineral in a certain volume of bone,
which is an indirect indicator of bone strength.
"Cost-sharing." The following:
(1) The share of the health care costs covered by a
health insurance policy that an enrollee or covered person
pays out of pocket.
(2) The term includes a deductible, coinsurance,
copayment or similar charge.
(3) The term does not include a premium, a balance
billed amount from an out-of-network provider or the cost of
a noncovered service.
"Department." The Department of Human Services of the
Commonwealth.
"Dietary supplement." A dietary supplement prescribed for
the maintenance or promotion of bone health.
"Health insurance policy." As defined in section 2102 of the
act of May 17, 1921 (P.L.682, No.284), known as The Insurance
Company Law of 1921.
"Menopause." The cessation of menstrual periods for 12
consecutive months, which can occur by a natural process of the
body or can be caused medically or surgically and may be
accompanied by any of the following symptoms:
(1) Irregular menstrual periods.
(2) Hot flashes.
(3) Vaginal or bladder problems.
(4) Decrease in fertility.
(5) Loss of bone density, including osteoporosis.
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(6) Elevated low-density lipoprotein cholesterol levels.
(7) Sleep disruption, including night sweats.
"Osteoporosis." A disease characterized by loss of bone mass
or structural deterioration, causing a decrease in bone strength
and an increased risk of fractures.
Section 5. Duties of department.
(a) Medical assistance coverage.--Subject to Federal
approval, the department shall provide medical assistance
coverage for screenings and treatments for osteoporosis for
eligible and enrolled medical assistance recipients who have
reached menopause. The coverage required under this section
shall, at a minimum, include:
(1) Coverage for bone mineral density testing.
(2) Coverage for hormonal and nonhormonal treatments
used to treat menopausal symptoms, including osteoporosis.
(3) Coverage for all drugs, devices and combination
products approved by the United States Food and Drug
Administration for the prevention or treatment of
osteoporosis.
(b) State plan amendment or Federal waiver.--The department
shall seek a State plan amendment or Federal waiver from the
Centers for Medicare and Medicaid Services, if needed, for the
provision of the services listed in this section under the
medical assistance program.
Section 6. Duties of insurers.
(a) Coverage requirement.--A health insurance policy
offered, issued or renewed in this Commonwealth shall provide
coverage of preventative measures, testing and treatments for
osteoporosis for covered individuals who have reached menopause.
The coverage required under this section shall, at a minimum,
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include:
(1) Coverage for bone mineral density testing.
(2) Coverage or reimbursement for preventative measures,
including:
(i) Dietary supplements.
(ii) Weight training or personal training services.
(iii) Physical therapy.
(3) Coverage for hormonal and nonhormonal treatments
used to treat menopausal symptoms, including osteoporosis.
(4) Coverage for all drugs, devices and combination
products approved by the United States Food and Drug
Administration for the prevention or treatment of
osteoporosis.
(b) Terms and conditions.--The coverage required under this
section shall be subject to the terms and conditions of a health
insurance policy, including provisions relating to medical
necessity, cost-sharing and utilization review.
(c) Condition.--Coverage may be conditioned upon the covered
individual receiving a prescription for the items under
subsection (a)(2).
Section 7. Applicability.
This act shall apply as follows:
(1) For a health insurance policy for which either rates
or forms are required to be filed with the Insurance
Department, this act shall apply to a policy for which a form
or rate is first filed on or after the effective date of this
paragraph.
(2) For a health insurance policy for which neither
rates nor forms are required to be filed with the Insurance
Department, this act shall apply to a policy issued or
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renewed on or after 180 days after the effective date of this
paragraph.
Section 8. Effective date.
This act shall take effect in 90 days.
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