Rhode Island 2025 Regular Session

Rhode Island House Bill H5626 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- H 5626
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7	7	LC002031
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
16	16	Introduced By: Representatives Speakman, Knight, Boylan, Donovan, Fogarty, Spears,
17	17	Cotter, Carson, Tanzi, and Alzate
18	18	Date Introduced: February 26, 2025
19	19	Referred To: House Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
24	24	Policies" is hereby amended by adding thereto the following section: 2
25	25	27-18-57.1. Coverage for contraceptive drugs, devices or therapeutic equivalent. 3
26	26	(a) Notwithstanding any other provision of this chapter, any health insurance contract, plan, 4
27	27	or policy delivered or issued for delivery or renewed in this state, except contracts providing 5
28	28	supplemental coverage to Medicare or other governmental programs, shall provide coverage for 6
29	29	the following services and contraceptive methods: 7
30	30	(1) United States Food and Drug Administration (FDA) approved contraceptive drugs, 8
31	31	devices and other products; provided, however, that coverage shall not be required for male 9
32	32	condoms or FDA-approved oral contraceptive drugs that do not have a therapeutic equivalent; and 10
33	33	provided further, that: 11
34	34	(i) If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, 12
35	35	device or product, the office of the health insurance commissioner shall not be required to include 13
36	36	all such therapeutically equivalent versions in its formulary as long as at least one is included and 14
37	37	covered without cost-sharing and in accordance with this section; and 15
38	38	(ii) If there is a therapeutic equivalent of a drug, device or other product for an FDA-16
39	39	approved contraceptive method, the insurer may provide coverage for more than one drug, device 17
40	40	or other product and may impose cost-sharing requirements as long as at least one drug, device or 18
41	41	other product for that method is available without cost-sharing; provided, however, that if an 19
42	42
43	43
44	44	LC002031 - Page 2 of 8
45	45	individual’s provider recommends a particular FDA-approved contraceptive based on a medical 1
46	46	determination with respect to that individual, regardless of whether the contraceptive has a 2
47	47	therapeutic equivalent, the insurer shall provide coverage for the prescribed contraceptive drug, 3
48	48	device or product without cost-sharing; 4
49	49	(2) FDA-approved emergency contraception available over-the-counter, whether with a 5
50	50	prescription or dispensed consistent with the requirements of current law; 6
51	51	(3) Prescription contraceptives intended to last: 7
52	52	(i) For not more than a three (3) month period for the first time the prescription 8
53	53	contraceptive is dispensed to the covered person; and 9
54	54	(ii) For not more than a twelve (12) month period for any subsequent dispensing of the 10
55	55	same prescription, which may be dispensed all at once or over the course of the twelve (12) month 11
56	56	period, regardless of whether the covered person was enrolled in a plan or policy under this chapter 12
57	57	at the time the prescription contraceptive was first dispensed; provided, however, that the insured 13
58	58	may not fill more than one twelve (12) month prescription in a single dispensing per plan year; 14
59	59	(4) Voluntary female sterilization procedures; 15
60	60	(5) Patient education and counseling on contraception; and 16
61	61	(6) Follow-up services related to the drugs, devices, products and procedures covered under 17
62	62	this subsection including, but not limited to, management of side effects, counseling for continued 18
63	63	adherence and device insertion and removal. 19
64	64	(b) For purposes of this section, the following words shall have the following meanings 20
65	65	unless the context clearly requires otherwise: 21
66	66	(1) “Provider” means an individual or facility licensed, certified, or otherwise authorized 22
67	67	or permitted by law to administer health care in the ordinary course of business or professional 23
68	68	practice acting within the scope of their license. 24
69	69	(2) “Therapeutic equivalent” means a contraceptive drug, device, or product that is: 25
70	70	(i) Approved by the FDA as safe and effective; 26
71	71	(ii) Pharmaceutically equivalent to another contraceptive drug, device, or product in that it 27
72	72	contains an identical amount of the same active drug ingredient in the same dosage form and route 28
73	73	of administration and meets compendial or other applicable standards of strength, quality, purity, 29
74	74	and identity; and 30
75	75	(iii) Assigned the same therapeutic equivalence code as another contraceptive drug, device 31
76	76	or product by the FDA. 32
77	77	(c) Coverage provided under this section shall not be subject to any deductible, 33
78	78	coinsurance, copayment, or other cost-sharing requirement, except as otherwise required under 34
79	79
80	80
81	81	LC002031 - Page 3 of 8
82	82	federal law. Coverage offered under this section shall not impose unreasonable restrictions or 1
83	83	delays in the coverage; provided, however, that reasonable medical management techniques may 2
84	84	be applied to coverage within a method category, as defined by the FDA, but not across types of 3
85	85	methods. 4
86	86	(d) Benefits for an enrollee under this section shall be the same for the enrollee’s covered 5
87	87	spouse and covered dependents. 6
88	88	(e) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 7
89	89	devices, products, and procedures as prescribed by a provider for reasons other than contraceptive 8
90	90	purposes including, but not limited to, decreasing the risk of ovarian cancer, eliminating symptoms 9
91	91	of menopause or providing contraception that is necessary to preserve the life or health of the 10
92	92	enrollee or the enrollee’s covered spouse or covered dependents. 11
93	93	(f) The office of the health insurance commissioner shall ensure plan compliance with this 12
94	94	section. 13
95	95	(g) Nothing in this section shall be construed to require insurers to cover experimental or 14
96	96	investigational treatments. 15
97	97	SECTION 2. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 16
98	98	Corporations" is hereby amended by adding thereto the following section: 17
99	99	27-20-43.1. Coverage for contraceptive drugs, devices or therapeutic equivalent. 18
100	100	(a) Notwithstanding any other provision of this chapter, any health insurance contract, plan, 19
101	101	or policy delivered or issued for delivery or renewed in this state, except contracts providing 20
102	102	supplemental coverage to Medicare or other governmental programs, shall provide coverage for 21
103	103	the following services and contraceptive methods: 22
104	104	(1) United States Food and Drug Administration (FDA) approved contraceptive drugs, 23
105	105	devices and other products; provided, however, that coverage shall not be required for male 24
106	106	condoms or FDA-approved oral contraceptive drugs that do not have a therapeutic equivalent; and 25
107	107	provided further, that: 26
108	108	(i) If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, 27
109	109	device or product, the office of the health insurance commissioner shall not be required to include 28
110	110	all such therapeutically equivalent versions in its formulary as long as at least one is included and 29
111	111	covered without cost-sharing and in accordance with this section; and 30
112	112	(ii) If there is a therapeutic equivalent of a drug, device or other product for an FDA-31
113	113	approved contraceptive method, the insurer may provide coverage for more than one drug, device 32
114	114	or other product and may impose cost-sharing requirements as long as at least one drug, device or 33
115	115	other product for that method is available without cost-sharing; provided, however, that if an 34
116	116
117	117
118	118	LC002031 - Page 4 of 8
119	119	individual’s provider recommends a particular FDA-approved contraceptive based on a medical 1
120	120	determination with respect to that individual, regardless of whether the contraceptive has a 2
121	121	therapeutic equivalent, the insurer shall provide coverage for the prescribed contraceptive drug, 3
122	122	device or product without cost-sharing; 4
123	123	(2) FDA-approved emergency contraception available over-the-counter, whether with a 5
124	124	prescription or dispensed consistent with the requirements of current law; 6
125	125	(3) Prescription contraceptives intended to last: 7
126	126	(i) For not more than a three (3) month period for the first time the prescription 8
127	127	contraceptive is dispensed to the covered person; and 9
128	128	(ii) For not more than a twelve (12) month period for any subsequent dispensing of the 10
129	129	same prescription, which may be dispensed all at once or over the course of the twelve (12) month 11
130	130	period, regardless of whether the covered person was enrolled in a plan or policy under this chapter 12
131	131	at the time the prescription contraceptive was first dispensed; provided, however, that the insured 13
132	132	may not fill more than one twelve (12) month prescription in a single dispensing per plan year; 14
133	133	(4) Voluntary female sterilization procedures; 15
134	134	(5) Patient education and counseling on contraception; and 16
135	135	(6) Follow-up services related to the drugs, devices, products and procedures covered under 17
136	136	this subsection including, but not limited to, management of side effects, counseling for continued 18
137	137	adherence and device insertion and removal. 19
138	138	(b) For purposes of this section, the following words shall have the following meanings 20
139	139	unless the context clearly requires otherwise: 21
140	140	(1) “Provider” means an individual or facility licensed, certified, or otherwise authorized 22
141	141	or permitted by law to administer health care in the ordinary course of business or professional 23
142	142	practice acting within the scope of their license. 24
143	143	(2) “Therapeutic equivalent” means a contraceptive drug, device, or product that is: 25
144	144	(i) Approved by the FDA as safe and effective; 26
145	145	(ii) Pharmaceutically equivalent to another contraceptive drug, device, or product in that it 27
146	146	contains an identical amount of the same active drug ingredient in the same dosage form and route 28
147	147	of administration and meets compendial or other applicable standards of strength, quality, purity, 29
148	148	and identity; and 30
149	149	(iii) Assigned the same therapeutic equivalence code as another contraceptive drug, device 31
150	150	or product by the FDA. 32
151	151	(c) Coverage provided under this section shall not be subject to any deductible, 33
152	152	coinsurance, copayment, or other cost-sharing requirement, except as otherwise required under 34
153	153
154	154
155	155	LC002031 - Page 5 of 8
156	156	federal law. Coverage offered under this section shall not impose unreasonable restrictions or 1
157	157	delays in the coverage; provided, however, that reasonable medical management techniques may 2
158	158	be applied to coverage within a method category, as defined by the FDA, but not across types of 3
159	159	methods. 4
160	160	(d) Benefits for an enrollee under this section shall be the same for the enrollee’s covered 5
161	161	spouse and covered dependents. 6
162	162	(e) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 7
163	163	devices, products, and procedures as prescribed by a provider for reasons other than contraceptive 8
164	164	purposes including, but not limited to, decreasing the risk of ovarian cancer, eliminating symptoms 9
165	165	of menopause or providing contraception that is necessary to preserve the life or health of the 10
166	166	enrollee or the enrollee’s covered spouse or covered dependents. 11
167	167	(f) The office of the health insurance commissioner shall ensure plan compliance with this 12
168	168	section. 13
169	169	(g) Nothing in this section shall be construed to require insurers to cover experimental or 14
170	170	investigational treatments. 15
171	171	SECTION 3. Chapter 27-41 of the General Laws entitled "Health Maintenance 16
172	172	Organizations" is hereby amended by adding thereto the following section: 17
173	173	27-41-59.1. Coverage for contraceptive drugs, devices or therapeutic equivalent. 18
174	174	(a) Notwithstanding any other provision of this chapter, any health insurance contract, plan, 19
175	175	or policy delivered or issued for delivery or renewed in this state, except contracts providing 20
176	176	supplemental coverage to Medicare or other governmental programs, shall provide coverage for 21
177	177	the following services and contraceptive methods: 22
178	178	(1) United States Food and Drug Administration (FDA) approved contraceptive drugs, 23
179	179	devices and other products; provided, however, that coverage shall not be required for male 24
180	180	condoms or FDA-approved oral contraceptive drugs that do not have a therapeutic equivalent; and 25
181	181	provided further, that: 26
182	182	(i) If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, 27
183	183	device or product, the office of the health insurance commissioner shall not be required to include 28
184	184	all such therapeutically equivalent versions in its formulary as long as at least one is included and 29
185	185	covered without cost-sharing and in accordance with this section; and 30
186	186	(ii) If there is a therapeutic equivalent of a drug, device or other product for an FDA-31
187	187	approved contraceptive method, the insurer may provide coverage for more than one drug, device 32
188	188	or other product and may impose cost-sharing requirements as long as at least one drug, device or 33
189	189	other product for that method is available without cost-sharing; provided, however, that if an 34
190	190
191	191
192	192	LC002031 - Page 6 of 8
193	193	individual’s provider recommends a particular FDA-approved contraceptive based on a medical 1
194	194	determination with respect to that individual, regardless of whether the contraceptive has a 2
195	195	therapeutic equivalent, the insurer shall provide coverage for the prescribed contraceptive drug, 3
196	196	device or product without cost-sharing; 4
197	197	(2) FDA-approved emergency contraception available over-the-counter, whether with a 5
198	198	prescription or dispensed consistent with the requirements of current law; 6
199	199	(3) Prescription contraceptives intended to last: 7
200	200	(i) For not more than a three (3) month period for the first time the prescription 8
201	201	contraceptive is dispensed to the covered person; and 9
202	202	(ii) For not more than a twelve (12) month period for any subsequent dispensing of the 10
203	203	same prescription, which may be dispensed all at once or over the course of the twelve (12) month 11
204	204	period, regardless of whether the covered person was enrolled in a plan or policy under this chapter 12
205	205	at the time the prescription contraceptive was first dispensed; provided, however, that the insured 13
206	206	may not fill more than one twelve (12) month prescription in a single dispensing per plan year; 14
207	207	(4) Voluntary female sterilization procedures; 15
208	208	(5) Patient education and counseling on contraception; and 16
209	209	(6) Follow-up services related to the drugs, devices, products and procedures covered under 17
210	210	this subsection including, but not limited to, management of side effects, counseling for continued 18
211	211	adherence and device insertion and removal. 19
212	212	(b) For purposes of this section, the following words shall have the following meanings 20
213	213	unless the context clearly requires otherwise: 21
214	214	(1) “Provider” means an individual or facility licensed, certified, or otherwise authorized 22
215	215	or permitted by law to administer health care in the ordinary course of business or professional 23
216	216	practice acting within the scope of their license. 24
217	217	(2) “Therapeutic equivalent” means a contraceptive drug, device, or product that is: 25
218	218	(i) Approved by the FDA as safe and effective; 26
219	219	(ii) Pharmaceutically equivalent to another contraceptive drug, device, or product in that it 27
220	220	contains an identical amount of the same active drug ingredient in the same dosage form and route 28
221	221	of administration and meets compendial or other applicable standards of strength, quality, purity, 29
222	222	and identity; and 30
223	223	(iii) Assigned the same therapeutic equivalence code as another contraceptive drug, device 31
224	224	or product by the FDA. 32
225	225	(c) Coverage provided under this section shall not be subject to any deductible, 33
226	226	coinsurance, copayment, or other cost-sharing requirement, except as otherwise required under 34
227	227
228	228
229	229	LC002031 - Page 7 of 8
230	230	federal law. Coverage offered under this section shall not impose unreasonable restrictions or 1
231	231	delays in the coverage; provided, however, that reasonable medical management techniques may 2
232	232	be applied to coverage within a method category, as defined by the FDA, but not across types of 3
233	233	methods. 4
234	234	(d) Benefits for an enrollee under this section shall be the same for the enrollee’s covered 5
235	235	spouse and covered dependents. 6
236	236	(e) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 7
237	237	devices, products, and procedures as prescribed by a provider for reasons other than contraceptive 8
238	238	purposes including, but not limited to, decreasing the risk of ovarian cancer, eliminating symptoms 9
239	239	of menopause or providing contraception that is necessary to preserve the life or health of the 10
240	240	enrollee or the enrollee’s covered spouse or covered dependents. 11
241	241	(f) The office of the health insurance commissioner shall ensure plan compliance with this 12
242	242	section. 13
243	243	(g) Nothing in this section shall be construed to require insurers to cover experimental or 14
244	244	investigational treatments. 15
245	245	SECTION 4. This act shall take effect on January 1, 2026. 16
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250	250
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252	252	EXPLANATION
253	253	BY THE LEGISLATIVE COUNCIL
254	254	OF
255	255	A N A C T
256	256	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
257	257	***
258	258	This act would mandate health insurance coverage for at least one FDA-approved 1
259	259	contraceptive drug, device or therapeutic equivalent, emergency contraception available over-the-2
260	260	counter, as well as voluntary female sterilization procedures; patient education and counseling on 3
261	261	contraception; and follow-up services related to the drugs, devices, products and procedures. 4
262	262	This act would take effect on January 1, 2026. 5
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