| 1 | | - | Enrolled September 04, 2024 Passed IN Senate August 29, 2024 Passed IN Assembly August 30, 2024 Amended IN Senate August 23, 2024 Amended IN Senate June 26, 2024 Amended IN Assembly May 20, 2024 Amended IN Assembly April 25, 2024 Amended IN Assembly March 04, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2467Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Rubio)February 13, 2024An act to add Section 1367.252 to the Health and Safety Code, and to add Section 10123.1962 to the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTAB 2467, Bauer-Kahan. Health care coverage for menopause.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for health care service plan contracts and health insurance policies.This bill would require a health care service plan contract or health insurance policy, except as specified, to include coverage for evaluation and treatment options for perimenopause and menopause. The bill would require a health care service plan or health insurer to annually provide clinical care recommendations, as specified, for hormone therapy to all contracted primary care providers who treat individuals with perimenopause and menopause. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.252 is added to the Health and Safety Code, to read:1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter.(g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. SEC. 2. Section 10123.1962 is added to the Insurance Code, to read:10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 1 | + | Amended IN Senate August 23, 2024 Amended IN Senate June 26, 2024 Amended IN Assembly May 20, 2024 Amended IN Assembly April 25, 2024 Amended IN Assembly March 04, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2467Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Rubio)February 13, 2024An act to add Section 1367.252 to the Health and Safety Code, and to add Section 10123.1962 to the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTAB 2467, as amended, Bauer-Kahan. Health care coverage for menopause.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for health care service plan contracts and health insurance policies.This bill would require a health care service plan contract or health insurance policy, except for a specialized contract or policy, that is issued, amended, or renewed on or after January 1, 2025, as specified, to include coverage for evaluation and treatment options for perimenopause and menopause. The bill would require a health care service plan or health insurer to annually provide clinical care recommendations, as specified, for hormone therapy to all contracted primary care providers who treat individuals with perimenopause and menopause. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.252 is added to the Health and Safety Code, to read:1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter.(g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. SEC. 2. Section 10123.1962 is added to the Insurance Code, to read:10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 40 | 37 | | |
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| 41 | 38 | | The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. |
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| 42 | 39 | | |
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| 43 | 40 | | This bill would provide that no reimbursement is required by this act for a specified reason. |
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| 44 | 41 | | |
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| 45 | 42 | | ## Digest Key |
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| 46 | 43 | | |
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| 47 | 44 | | ## Bill Text |
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| 48 | 45 | | |
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| 49 | 46 | | The people of the State of California do enact as follows:SECTION 1. Section 1367.252 is added to the Health and Safety Code, to read:1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter.(g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. SEC. 2. Section 10123.1962 is added to the Insurance Code, to read:10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 50 | 47 | | |
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| 51 | 48 | | The people of the State of California do enact as follows: |
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| 52 | 49 | | |
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| 53 | 50 | | ## The people of the State of California do enact as follows: |
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| 54 | 51 | | |
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| 55 | 52 | | SECTION 1. Section 1367.252 is added to the Health and Safety Code, to read:1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter.(g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. |
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| 56 | 53 | | |
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| 57 | 54 | | SECTION 1. Section 1367.252 is added to the Health and Safety Code, to read: |
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| 58 | 55 | | |
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| 59 | 56 | | ### SECTION 1. |
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| 60 | 57 | | |
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| 61 | 58 | | 1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter.(g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. |
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| 62 | 59 | | |
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| 63 | 60 | | 1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter.(g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. |
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| 64 | 61 | | |
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| 65 | 62 | | 1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter.(g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. |
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| 66 | 63 | | |
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| 67 | 64 | | |
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| 68 | 65 | | |
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| 69 | 66 | | 1367.252. (a) A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following: |
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| 70 | 67 | | |
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| 71 | 68 | | (1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy. |
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| 72 | 69 | | |
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| 73 | 70 | | (2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom. |
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| 74 | 71 | | |
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| 75 | 72 | | (3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause. |
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| 76 | 73 | | |
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| 77 | 74 | | (4) At least one from each class of medications approved to prevent and treat osteoporosis. |
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| 78 | 75 | | |
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| 79 | 76 | | (b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations. |
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| 80 | 77 | | |
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| 81 | 78 | | (c) A health care service plan shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat enrollees with perimenopause and menopause. A health care service plan shall encourage primary care providers to review those recommendations. |
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| 82 | 79 | | |
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| 83 | 80 | | (d) For purposes of this section, the following terms have the following meanings: |
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| 84 | 81 | | |
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| 85 | 82 | | (1) Formulation means all of the following: |
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| 86 | 83 | | |
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| 87 | 84 | | (A) A tablet or capsule. |
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| 88 | 85 | | |
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| 89 | 86 | | (B) A transdermal patch. |
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| 90 | 87 | | |
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| 91 | 88 | | (C) A topical spray. |
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| 92 | 89 | | |
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| 93 | 90 | | (D) A cream, gel, or lotion. |
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| 94 | 91 | | |
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| 95 | 92 | | (E) A vaginal suppository, cream, or silicone ring. |
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| 96 | 93 | | |
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| 97 | 94 | | (2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration. |
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| 98 | 95 | | |
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| 99 | 96 | | (e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity. |
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| 100 | 97 | | |
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| 101 | 98 | | (f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 1342.71 or any other provision under this chapter. |
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| 102 | 99 | | |
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| 103 | 100 | | (g) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. |
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| 104 | 101 | | |
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| 105 | 102 | | SEC. 2. Section 10123.1962 is added to the Insurance Code, to read:10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter. |
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| 106 | 103 | | |
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| 107 | 104 | | SEC. 2. Section 10123.1962 is added to the Insurance Code, to read: |
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| 108 | 105 | | |
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| 109 | 106 | | ### SEC. 2. |
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| 110 | 107 | | |
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| 111 | 108 | | 10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter. |
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| 112 | 109 | | |
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| 113 | 110 | | 10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter. |
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| 114 | 111 | | |
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| 115 | 112 | | 10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following:(1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy.(2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom.(3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause.(4) At least one from each class of medications approved to prevent and treat osteoporosis.(b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations.(c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations.(d) For purposes of this section, the following terms have the following meanings:(1) Formulation means all of the following:(A) A tablet or capsule.(B) A transdermal patch.(C) A topical spray.(D) A cream, gel, or lotion.(E) A vaginal suppository, cream, or silicone ring.(2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration.(e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity.(f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter. |
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| 116 | 113 | | |
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| 117 | 114 | | |
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| 118 | 115 | | |
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| 119 | 116 | | 10123.1962. (a) A health insurance policy, except for a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2025, shall include coverage for evaluation and treatment options for perimenopause and menopause, as is deemed medically necessary by the treating health care provider without utilization management, that includes, but is not limited to, all of the following: |
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| 120 | 117 | | |
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| 121 | 118 | | (1) At least one option in each formulation of, and the associated method of administration for, federal Food and Drug Administration-regulated systemic hormone therapy. |
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| 122 | 119 | | |
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| 123 | 120 | | (2) At least one option in each formulation of, and the associated method of administration for, nonhormonal medications for each menopause symptom. |
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| 124 | 121 | | |
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| 125 | 122 | | (3) At least one option in each formulation of, and the associated method of administration for, treatment for genitourinary syndrome of menopause. |
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| 126 | 123 | | |
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| 127 | 124 | | (4) At least one from each class of medications approved to prevent and treat osteoporosis. |
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| 128 | 125 | | |
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| 129 | 126 | | (b) Coverage required under this section includes authority for the treating provider to adjust the dose of a drug consistent with clinical care recommendations. |
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| 130 | 127 | | |
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| 131 | 128 | | (c) A health insurer shall annually provide current clinical care recommendations for hormone therapy from the Menopause Society or other nationally recognized professional associations to all contracted primary care providers who treat insureds with perimenopause and menopause. A health insurer shall encourage primary care providers to review those recommendations. |
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| 132 | 129 | | |
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| 133 | 130 | | (d) For purposes of this section, the following terms have the following meanings: |
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| 134 | 131 | | |
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| 135 | 132 | | (1) Formulation means all of the following: |
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| 136 | 133 | | |
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| 137 | 134 | | (A) A tablet or capsule. |
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| 138 | 135 | | |
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| 139 | 136 | | (B) A transdermal patch. |
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| 140 | 137 | | |
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| 141 | 138 | | (C) A topical spray. |
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| 142 | 139 | | |
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| 143 | 140 | | (D) A cream, gel, or lotion. |
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| 144 | 141 | | |
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| 145 | 142 | | (E) A vaginal suppository, cream, or silicone ring. |
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| 146 | 143 | | |
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| 147 | 144 | | (2) Method of administration means administering a formulation via an oral, topical, vaginal, subcutaneous, injectable, or intravenous route of administration. |
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| 148 | 145 | | |
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| 149 | 146 | | (e) Coverage for the evaluation and treatment options for perimenopause and menopause shall be provided without discrimination on the basis of gender expression or identity. |
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| 150 | 147 | | |
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| 151 | 148 | | (f) Nothing in this section shall be construed to limit coverage for medically necessary outpatient prescription drugs pursuant to Section 10123.193 or any other provision under this chapter. |
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| 152 | 149 | | |
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| 153 | 150 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 154 | 151 | | |
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| 155 | 152 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 156 | 153 | | |
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| 157 | 154 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution. |
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| 158 | 155 | | |
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| 159 | 156 | | ### SEC. 3. |
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