An Act providing for insurance coverage for vaginal estrogen for the treatment of menopausal symptoms and urinary tract infections.

PRINTER'S NO. 3452
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2545
Session of
2026
INTRODUCED BY SHUSTERMAN, D. WILLIAMS AND PARKER, MAY 27, 2026
REFERRED TO COMMITTEE ON INSURANCE, MAY 27, 2026
AN ACT
Providing for insurance coverage for vaginal estrogen for the
treatment of menopausal symptoms and urinary tract
infections.
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 Insurance
Coverage for Vaginal Estrogen Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"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
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billed amount from an out-of-network provider or the cost of
a noncovered service.
"Department." The Insurance Department of the Commonwealth.
"Health insurance policy." A policy, subscriber contract,
certificate or plan issued by an insurer that provides medical
or health care coverage. The term does not include any of the
following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A TRICARE policy, including a Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS)
supplement policy.
(7) A fixed indemnity policy.
(8) A hospital indemnity policy.
(9) A dental only policy.
(10) A vision only policy.
(11) A workers' compensation policy.
(12) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
(13) A homeowner's insurance policy.
(14) Any other similar policies providing for limited
benefits.
"Menopausal symptoms." Any of the following:
(1) Irregular menstrual periods.
(2) Hot flashes.
(3) Vaginal or bladder problems.
(4) Decrease in fertility.
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(5) Loss of bone density, including osteoporosis.
(6) Elevated low-density lipoprotein cholesterol levels.
(7) Sleep disruption, including night sweats.
"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 menopausal symptoms.
"Urinary tract infection." An infection that occurs in any
part of the urinary system.
"Vaginal estrogen." The hormone estrogen in a form that is
applied to or inserted into the vagina, vulva, opening of the
urethra or the cervix.
Section 3. Coverage requirement.
A health insurance policy offered, issued or renewed in this
Commonwealth after the effective date of this section shall
provide coverage for vaginal estrogen for the treatment of
menopausal symptoms and for the prevention of urinary tract
infections. The coverage required under this section shall, at a
minimum, include coverage for all drugs, devices and combination
products approved by the United States Food and Drug
Administration for the provision or administration of vaginal
estrogen. 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.
Section 4. 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 department, this
act shall apply to a policy for which a form or rate is first
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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 department,
this act shall apply to a policy issued or renewed on or
after 180 days from the effective date of this paragraph.
Section 5. Effective date.
This act shall take effect in 90 days.
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