AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Requires every individual or group health insurance contract effective on or after January 1, 2027, to provide coverage to the insured and the insured's spouse and dependents for all FDA-approved contraceptive drugs, devices and other products.)

S2254

2026 -- S 2254
========
LC004195
========

STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By:
Senators Euer, Vargas, Lauria, Kallman, Lawson, Valverde, Quezada,
Mack, DiMario, and Murray

Date Introduced:
January 23, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident
2
and Sickness Insurance Policies" is hereby amended to read as follows:
3

27-18-57. FDA approved prescription contraceptive drugs and devices.
4
(a) Every individual or group health insurance contract, plan, or policy
issued pursuant to
5
this title
that
provides prescription coverage and
is delivered, issued for delivery,
or
renewed
,
6
amended or effective
in this state
on or after January 1, 2027
shall provide coverage for
FDA
7
approved contraceptive drugs and devices requiring a prescription

all of the following services and
8
contraceptive methods
. Provided, that nothing in this subsection shall be deemed to mandate or
9
require coverage for the prescription drug RU 486.
10

(1) All FDA-approved contraceptive drugs, devices, and other products. The following
11
applies to this coverage:
12

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or
13
product, the contract shall include either the original FDA-approved contraceptive drug, device, or
14
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same
15
definition as that set forth by the FDA;
16

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not
17
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or
18
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the
19
contraceptive drug, device, or product, based on the determination of the health care provider,

1
without cost-sharing; and
2

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-
3
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for
4
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical
5
management restrictions;
6

(2) Voluntary sterilization procedures;
7

(3) Clinical services related to the provision or use of contraception, including
8
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient
9
education, referrals, and counseling; and
10

(4) Follow-up services related to the drugs, devices, products, and procedures covered
11
under this section, including, but not limited to, management of side effects, counseling for
12
continued adherence, and device insertion and removal.
13

(b) A group or blanket policy subject to this section shall not impose a deductible,
14
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant
15
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier
16
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the
17
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and
18
withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not
19
impose utilization control or other forms of medical management limiting the supply of FDA-
20
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a
21
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less
22
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for
23
such coverage other than a pharmacy claim.
24

(c) Except as otherwise authorized under this section, a group or blanket policy shall not
25
impose any restrictions or delays on the coverage required under this section.
26

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered
27
spouse or domestic partner and covered non-spouse dependents.
28

(b)
(e)
Notwithstanding any other provision of this section, any insurance company may
29
issue to a religious employer an individual or group health insurance contract, plan, or policy that
30
excludes coverage for prescription contraceptive methods that are contrary to the religious
31
employer’s bona fide religious tenets.
The exclusion from coverage under this subsection shall not
32
apply to contraceptive services or procedures provided for purposes other than contraception, such
33
as decreasing the risk of ovarian cancer or eliminating symptoms of menopause.
34

(c)
(f)
As used in this section, “religious employer” means an employer that is a “church or

LC004195 - Page 2 of 15
1
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.
2

(d)
(g)
This section does not apply to insurance coverage providing benefits for: (1) Hospital
3
confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare
4
supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily
5
injury or death by accident or both; and (9) Other limited benefit policies.
6

(e)
(h)
Every religious employer that invokes the exemption provided under this section
7
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the
8
contraceptive healthcare services the employer refuses to cover for religious reasons.
9

(f)
(i)
Beginning on the first day of each plan year after April 1, 2019, every health insurance
10
issuer offering group or individual health insurance coverage that covers prescription contraception
11
shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three
12
hundred sixty-five (365) days at a time
that may be furnished or dispensed all at once or over the
13
course of the twelve (12) month period at the discretion of the prescriber
.
14

(j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,
15
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of
16
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to
17
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in
18
accordance with § 27-18-20. The office of the health insurance commissioner ("commissioner")
19
may base its determinations on findings from onsite surveys, enrollee or other complaints, financial
20
status, or any other source.
21

(k) The commissioner shall monitor plan compliance in accordance with this section and
22
shall adopt rules and regulations for the implementation of this section, including the following:
23

(1) In addition to any requirements under state administrative procedures, the
24
commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations
25
that include health care service plans, pharmacy benefit plans, consumer representatives, including
26
those representing youth, low-income people, and communities of color, and other interested
27
parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to
28
ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.
29
The commissioner shall provide notice of stakeholder meetings on the department's website, and
30
stakeholder meetings shall be open to the public.
31

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to
32
ensure compliance with this section.
33

(3) The commissioner shall submit an annual report to the general assembly and any other
34
appropriate entity with its findings from the random compliance reviews detailed in this section

LC004195 - Page 3 of 15
1
and any other compliance or implementation efforts. This report shall be made available to the
2
public on the commissioner's website.
3
SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit
4
Hospital Service Corporations" is hereby amended to read as follows:
5

27-19-48. FDA approved prescription contraceptive drugs and devices.
6
(a) Every individual or group health insurance contract, plan, or policy
issued pursuant to
7
this title
that
provides prescription coverage and
is delivered, issued for delivery,
or
renewed
,
8
amended or effective
in this state
on or after January 1, 2027
shall provide coverage for
FDA
9
approved contraceptive drugs and devices requiring a prescription

all of the following services and
10
contraceptive methods
. Provided, that nothing in this subsection shall be deemed to mandate or
11
require coverage for the prescription drug RU 486.
12

(1) All FDA-approved contraceptive drugs, devices, and other products. The following
13
applies to this coverage:
14

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or
15
product, the contract shall include either the original FDA-approved contraceptive drug, device, or
16
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same
17
definition as that set forth by the FDA;
18

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not
19
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or
20
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the
21
contraceptive drug, device, or product, based on the determination of the health care provider,
22
without cost-sharing; and
23

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-
24
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for
25
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical
26
management restrictions;
27

(2) Voluntary sterilization procedures;
28

(3) Clinical services related to the provision or use of contraception, including
29
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient
30
education, referrals, and counseling; and
31

(4) Follow-up services related to the drugs, devices, products, and procedures covered
32
under this section, including, but not limited to, management of side effects, counseling for
33
continued adherence, and device insertion and removal.
34

(b) A group or blanket policy subject to this section shall not impose a deductible,

LC004195 - Page 4 of 15
1
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant
2
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier
3
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the
4
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and
5
withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not
6
impose utilization control or other forms of medical management limiting the supply of FDA-
7
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a
8
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less
9
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for
10
such coverage other than a pharmacy claim.
11

(c) Except as otherwise authorized under this section, a group or blanket policy shall not
12
impose any restrictions or delays on the coverage required under this section.
13

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered
14
spouse or domestic partner and covered non-spouse dependents.
15

(b)
(e)
Notwithstanding any other provision of this section, any hospital service corporation
16
may issue to a religious employer an individual or group health insurance contract, plan, or policy
17
that excludes coverage for prescription contraceptive methods that are contrary to the religious
18
employer’s bona fide religious tenets.
The exclusion from coverage under this subsection shall not
19
apply to contraceptive services or procedures provided for purpose other than contraception, such
20
as decreasing the risk of ovarian cancer or eliminating symptoms of menopause.
21

(c)
(f)
As used in this section, “religious employer” means an employer that is a “church or
22
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.
23

(d)
(g)
Every religious employer that invokes the exemption provided under this section
24
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the
25
contraceptive healthcare services the employer refuses to cover for religious reasons.
26

(e)
(h)
Beginning on the first day of each plan year after April 1, 2019, every health
27
insurance issuer offering group or individual health insurance coverage that covers prescription
28
contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive
29
up to three hundred sixty-five (365) days at a time
that may be furnished or dispensed all at once
30
or over the course of the twelve (12) month period at the discretion of the prescriber
.
31

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,
32
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of
33
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to
34
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in

LC004195 - Page 5 of 15
1
accordance with § 27-19-38. The commissioner may base its determinations on findings from
2
onsite surveys, enrollee or other complaints, financial status, or any other source.
3

(j) The commissioner shall monitor plan compliance in accordance with this section and
4
shall adopt rules and regulations for the implementation of this section, including the following:
5

(1) In addition to any requirements under state administrative procedures, the
6
commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations
7
that include health care service plans, pharmacy benefit plans, consumer representatives, including
8
those representing youth, low-income people, and communities of color, and other interested
9
parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to
10
ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.
11
The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and
12
stakeholder meetings shall be open to the public.
13

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to
14
ensure compliance with this section.
15

(3) The commissioner shall submit an annual report to the general assembly and any other
16
appropriate entity with its findings from the random compliance reviews detailed in this section
17
and any other compliance or implementation efforts. This report shall be made available to the
18
public on the commissioner's website.
19
SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit
20
Medical Service Corporations" is hereby amended to read as follows:
21

27-20-43. FDA approved prescription contraceptive drugs and devices.
22
(a) Every individual or group health insurance contract, plan, or policy
issued pursuant to
23
this title
that
provides prescription coverage and
is delivered, issued for delivery,
or
renewed
,
24
amended or effective
in this state
on or after January 1, 2027
shall provide coverage for
FDA
25
approved contraceptive drugs and devices requiring a prescription

all of the following services and
26
contraceptive methods
. Provided, that nothing in this subsection shall be deemed to mandate or
27
require coverage for the prescription drug RU 486.
28

(1) All FDA-approved contraceptive drugs, devices and other products. The following
29
applies to this coverage:
30

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or
31
product, the contract shall include either the original FDA-approved contraceptive drug, device, or
32
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same
33
definition as that set forth by the FDA;
34

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

LC004195 - Page 6 of 15
1
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or
2
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the
3
contraceptive drug, device, or product, based on the determination of the health care provider,
4
without cost-sharing; and
5

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-
6
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for
7
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical
8
management restrictions;
9

(2) Voluntary sterilization procedures;
10

(3) Clinical services related to the provision or use of contraception, including
11
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient
12
education, referrals, and counseling; and
13

(4) Follow-up services related to the drugs, devices, products, and procedures covered
14
under this section, including, but not limited to, management of side effects, counseling for
15
continued adherence, and device insertion and removal.
16

(b) A group or blanket policy subject to this section shall not impose a deductible,
17
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant
18
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier
19
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the
20
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and
21
withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not
22
impose utilization control or other forms of medical management limiting the supply of FDA-
23
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a
24
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less
25
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for
26
such coverage other than a pharmacy claim.
27

(c) Except as otherwise authorized under this section, a group or blanket policy shall not
28
impose any restrictions or delays on the coverage required under this section.
29

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered
30
spouse or domestic partner and covered non-spouse dependents.
31

(b)
(e)
Notwithstanding any other provision of this section, any medical service corporation
32
may issue to a religious employer an individual or group health insurance contract, plan, or policy
33
that excludes coverage for prescription contraceptive methods that are contrary to the religious
34
employer’s bona fide religious tenets.
The exclusion from coverage under this subsection, shall not

LC004195 - Page 7 of 15
1
apply to contraceptive services or procedures provided for purposes other than contraception, such
2
as decreasing the risk of ovarian cancer or eliminating symptoms of menopause.
3

(c)
(f)
As used in this section, “religious employer” means an employer that is a “church or
4
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.
5

(d)
(g)
Every religious employer that invokes the exemption provided under this section
6
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the
7
contraceptive healthcare services the employer refuses to cover for religious reasons.
8

(e)
(h)
Beginning on the first day of each plan year after April 1, 2019, every health
9
insurance issuer offering group or individual health insurance coverage that covers prescription
10
contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive
11
up to three hundred sixty-five (365) days at a time
that may be furnished or dispensed all at once
12
or over the course of the twelve (12) month period at the discretion of the prescriber
.
13

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,
14
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of
15
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to
16
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in
17
accordance with § 27-20-33. The commissioner may base its determinations on findings from
18
onsite surveys, enrollee or other complaints, financial status, or any other source.
19

(j) The commissioner shall monitor plan compliance in accordance with this section and
20
shall adopt rules and regulations for the implementation of this section, including the following:
21

(1) In addition to any requirements under state administrative procedures, the
22
commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations
23
that include health care service plans, pharmacy benefit plans, consumer representatives, including
24
those representing youth, low-income people, and communities of color, and other interested
25
parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to
26
ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.
27
The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and
28
stakeholder meetings shall be open to the public.
29

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to
30
ensure compliance with this section.
31

(3) The commissioner shall submit an annual report to the general assembly and any other
32
appropriate entity with its findings from the random compliance reviews detailed in this section
33
and any other compliance or implementation efforts. This report shall be made available to the
34
public on the commissioner's website.

LC004195 - Page 8 of 15
1
SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health
2
Maintenance Organizations" is hereby amended to read as follows:
3

27-41-59. FDA approved prescription contraceptive drugs and devices.
4
(a) Every individual or group health insurance contract, plan, or policy
issued pursuant to
5
this title
that
provides prescription coverage and
is delivered, issued for delivery,
or
renewed
,
6
amended or effective
in this state
on or after January 1, 2027
shall provide coverage for
FDA
7
approved contraceptive drugs and devices requiring a prescription; provided,

all of the following
8
services and contraceptive methods.

Provided,
that nothing in this subsection shall be deemed to
9
mandate or require coverage for the prescription drug RU 486.
10

(1) All FDA-approved contraceptive drugs, devices, and other products. The following
11
applies to this coverage:
12

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or
13
product, the contract shall include either the original FDA-approved contraceptive drug, device, or
14
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same
15
definition as that set forth by the FDA;
16

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not
17
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or
18
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the
19
contraceptive drug, device, or product, based on the determination of the health care provider,
20
without cost-sharing; and
21

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-
22
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for
23
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical
24
management restrictions;
25

(2) Voluntary sterilization procedures;
26

(3) Clinical services related to the provision or use of contraception, including
27
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient
28
education, referrals, and counseling; and
29

(4) Follow-up services related to the drugs, devices, products, and procedures covered
30
under this section, including, but not limited to, management of side effects, counseling for
31
continued adherence, and device insertion and removal.
32

(b) A group or blanket policy subject to this section shall not impose a deductible,
33
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant
34
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier

LC004195 - Page 9 of 15
1
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the
2
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and
3
withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not
4
impose utilization control or other forms of medical management limiting the supply of FDA-
5
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a
6
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less
7
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for
8
such coverage other than a pharmacy claim.
9

(c) Except as otherwise authorized under this section, a group or blanket policy shall not
10
impose any restrictions or delays on the coverage required under this section.
11

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered
12
spouse or domestic partner and covered non-spouse dependents.
13

(b)
(e)
Notwithstanding any other provision of this section, any health maintenance
14
corporation may issue to a religious employer an individual or group health insurance contract,
15
plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to
16
the religious employer’s bona fide religious tenets.
The exclusion from coverage under this
17
subsection shall not apply to contraceptive services or procedures provided for purposes other than
18
contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of
19
menopause.
20

(c)
(f)
As used in this section, “religious employer” means an employer that is a “church or
21
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.
22

(d)
(g)
Every religious employer that invokes the exemption provided under this section
23
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the
24
contraceptive healthcare services the employer refuses to cover for religious reasons.
25

(e)
(h)
Beginning on the first day of each plan year after April 1, 2019, every health
26
insurance issuer offering group or individual health insurance coverage that covers prescription
27
contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive
28
up to three hundred sixty-five (365) days at a time
that may be furnished or dispensed all at once
29
or over the course of the twelve (12) month period at the discretion of the prescriber
.
30

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,
31
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of
32
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to
33
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in
34
accordance with § 27-41-21. The commissioner may base its determinations on findings from

LC004195 - Page 10 of 15
1
onsite surveys, enrollee or other complaints, financial status, or any other source.
2

(j) The commissioner shall monitor plan compliance in accordance with this section and
3
shall adopt rules and regulations for the implementation of this section, including the following:
4

(1) In addition to any requirements under state administrative procedures, the
5
commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations
6
that include health care service plans, pharmacy benefit plans, consumer representatives, including
7
those representing youth, low-income people, and communities of color, and other interested
8
parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to
9
ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.
10
The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and
11
stakeholder meetings shall be open to the public.
12

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to
13
ensure compliance with this section.
14

(3) The commissioner shall submit an annual report to the general assembly and any other
15
appropriate entity with its findings from the random compliance reviews detailed in this section
16
and any other compliance or implementation efforts. This report shall be made available to the
17
public on the commissioner's website.
18
SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby
19
amended by adding thereto the following section:
20

40-8-33. F.D.A. approved prescription contraceptive drugs and devices.
21

(a) Every individual or group health insurance contract, plan, or policy issued pursuant to
22
this chapter that is delivered, issued for delivery, renewed, amended or effective in this state on or
23
after January 1, 2027 shall provide coverage for all of the following services and contraceptive
24
methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage
25
for the prescription drug RU 486.
26

(1) All FDA-approved contraceptive drugs, devices, and other products. The following
27
applies to this coverage:
28

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or
29
product, the contract shall include either the original FDA-approved contraceptive drug, device, or
30
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same
31
definition as that set forth by the FDA;
32

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not
33
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or
34
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the

LC004195 - Page 11 of 15
1
contraceptive drug, device, or product, based on the determination of the health care provider,
2
without cost-sharing; and
3

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-
4
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for
5
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical
6
management restrictions;
7

(2) Voluntary sterilization procedures;
8

(3) Clinical services related to the provision or use of contraception, including
9
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient
10
education, referrals, and counseling; and
11

(4) Follow-up services related to the drugs, devices, products, and procedures covered
12
under this section, including, but not limited to, management of side effects, counseling for
13
continued adherence, and device insertion and removal.
14

(b) A group or blanket policy subject to this section shall not impose a deductible,
15
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant
16
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier
17
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the
18
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and
19
withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not
20
impose utilization control or other forms of medical management limiting the supply of FDA-
21
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a
22
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less
23
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for
24
such coverage other than a pharmacy claim.
25

(c) Except as otherwise authorized under this section, a group or blanket policy shall not
26
impose any restrictions or delays on the coverage required under this section.
27

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered
28
spouse or domestic partner and covered non-spouse dependents.
29

(e) Notwithstanding any other provision of this section, any health maintenance
30
corporation may issue to a religious employer an individual or group health insurance contract,
31
plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to
32
the religious employer's bona fide religious tenets. The exclusion from coverage under this
33
subsection shall not apply to contraceptive services or procedures provided for purposes other than
34
contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of

LC004195 - Page 12 of 15
1
menopause.
2

(f) As used in this section, "religious employer" means an employer that is a "church or a
3
qualified church-controlled organization" as defined in 26 U.S.C. § 3121.
4

(g) Every religious employer that invokes the exemption provided under this section shall
5
provide written notice to prospective enrollees prior to enrollment with the plan, listing the
6
contraceptive health care services the employer refuses to cover for religious reasons.
7

(h) Beginning on the first day of each plan year after April 1, 2024, every health insurance
8
issuer offering group or individual health insurance coverage that covers prescription contraception
9
shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three
10
hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the
11
course of the twelve (12) month period at the discretion of the prescriber.
12

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,
13
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of
14
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to
15
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in
16
accordance with § 40-8-9. The executive office of health and human services may base its
17
determinations on findings from onsite surveys, enrollee or other complaints, financial status, or
18
any other source.
19

(j) The executive office of health and human services shall monitor plan compliance in
20
accordance with this section and shall adopt and regulations rules for the implementation of this
21
section, including the following:
22

(1) In addition to any requirements under state administrative procedures, the executive
23
office of health and human services shall engage in a stakeholder process prior to the adoption of
24
rules and regulations that include health care service plans, pharmacy benefit plans, consumer
25
representatives, including those representing youth, low-income people, and communities of color,
26
and other interested parties. The executive office of health and human services shall hold
27
stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider
28
factors and processes relevant to contraceptive coverage. The executive office of health and human
29
services shall provide notice of stakeholder meetings on the executive office of health and human
30
services' website, and stakeholder meetings shall be open to the public.
31

(2) The executive office of health and human services shall conduct random reviews of
32
each plan and its subcontractors to ensure compliance with this section.
33

(3) The executive office of health and human services shall submit an annual report to the
34
general assembly and any other appropriate entity with its findings from the random compliance

LC004195 - Page 13 of 15
1
reviews detailed in this section and any other compliance or implementation efforts. This report
2
shall be made available to the public on the executive office of health and human services' website.
3
SECTION 6. This act shall take effect upon passage.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
1
This act would require every individual or group health insurance contract effective on or
2
after January 1, 2027, to provide coverage to the insured and the insured's spouse and dependents
3
for all FDA-approved contraceptive drugs, devices and other products, voluntary sterilization
4
procedures, patient education and counseling on contraception and follow-up services as well as
5
Medicaid coverage for a twelve (12) month supply for Medicaid recipients.
6
This act would take effect upon passage.
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LC004195 - Page 15 of 15