INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES, the official text

H8245 2026 -- H 8245 ======== LC005914 ======== 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: Representatives Donovan, Boylan, McGaw, Speakman, Spears, Cotter, Carson, Casimiro, Alzate, and Stewart Date Introduced: March 06, 2026 Referred To: House Health & Human Services It is enacted by the General Assembly as follows: 1 SECTION 1. Chapter 27-18 of the General Laws entitled Accident and Sickness Insurance 2 Policies is hereby amended by adding thereto the following section: 3 27-18-50.3. Prescription hormone therapy. 4 (a) As used in this section, prescription hormone therapy means all drugs approved by 5 the United States Food and Drug Administration that are used to medically suppress, increase, or 6 replace hormones that the body is not producing at intended levels, as determined by the prescribing 7 provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for 8 administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and 9 glucagon-like peptide-1 receptor agonists. 10 (b) Beginning on the first day of each plan year after January 1, 2027, every individual or 11 group health insurance contract, plan, or policy that provides prescription hormone therapy 12 coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement 13 for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at 14 one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the 15 enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled 16 substance. If the prescription hormone therapy is a controlled substance, the health plan shall 17 provide reimbursement for the maximum refill allowed under state and federal law to be obtained 18 at one time by the enrollee. 19 (c) Nothing in this section prohibits a health plan from limiting refills that may be obtained 1 in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription 2 hormone therapy has already been dispensed during the plan year. 3 (d) To the extent not otherwise prohibited under this section or state or federal law, health 4 plans may apply drug utilization management strategies to prescription drugs covered under 5 subsection (a) of this section. 6 (e) This section does not apply to insurance coverage providing benefits for: 7 (1) Hospital confinement indemnity; 8 (2) Disability income; 9 (3) Accident only; 10 (4) Long-term care; 11 (5) Medicare supplement; 12 (6) Limited benefit health; 13 (7) Specified disease indemnity; 14 (8) Sickness or bodily injury or death by accident or both; and 15 (9) Other limited-benefit policies. 16 SECTION 2. Chapter 27-19 of the General Laws entitled Nonprofit Hospital Service 17 Corporations is hereby amended by adding thereto the following section: 18 27-19-42.2. Prescription hormone therapy. 19 (a) As used in this section, prescription hormone therapy means all drugs approved by 20 the United States Food and Drug Administration that are used to medically suppress, increase, or 21 replace hormones that the body is not producing at intended levels, as determined by the prescribing 22 provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for 23 administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and 24 glucagon-like peptide-1 receptor agonists. 25 (b) Beginning on the first day of each plan year after January 1, 2027, every individual or 26 group health insurance contract, plan, or policy that provides prescription hormone therapy 27 coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement 28 for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at 29 one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the 30 enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled 31 substance. If the prescription hormone therapy is a controlled substance, the health plan shall 32 provide reimbursement for the maximum refill allowed under state and federal law to be obtained 33 at one time by the enrollee. 34 (c) Nothing in this section prohibits a health plan from limiting refills that may be obtained LC005914 - Page 2 of 7 1 in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription 2 hormone therapy has already been dispensed during the plan year. 3 (d) To the extent not otherwise prohibited under this section or state or federal law, health 4 plans may apply drug utilization management strategies to prescription drugs covered under 5 subsection (a) of this section. 6 (e) This section does not apply to insurance coverage providing benefits for: 7 (1) Hospital confinement indemnity; 8 (2) Disability income; 9 (3) Accident only; 10 (4) Long-term care; 11 (5) Medicare supplement; 12 (6) Limited benefit health; 13 (7) Specified disease indemnity; 14 (8) Sickness or bodily injury or death by accident or both; and 15 (9) Other limited-benefit policies. 16 SECTION 3. Chapter 27-20 of the General Laws entitled Nonprofit Medical Service 17 Corporations is hereby amended by adding thereto the following section: 18 27-20-23.4. Prescription hormone therapy. 19 (a) As used in this section, prescription hormone therapy means all drugs approved by 20 the United States Food and Drug Administration that are used to medically suppress, increase, or 21 replace hormones that the body is not producing at intended levels, as determined by the prescribing 22 provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for 23 administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and 24 glucagon-like peptide-1 receptor agonists. 25 (b) Beginning on the first day of each plan year after January 1, 2027, every individual or 26 group health insurance contract, plan, or policy that provides prescription hormone therapy 27 coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement 28 for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at 29 one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the 30 enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled 31 substance. If the prescription hormone therapy is a controlled substance, the health plan shall 32 provide reimbursement for the maximum refill allowed under state and federal law to be obtained 33 at one time by the enrollee. 34 (c) Nothing in this section prohibits a health plan from limiting refills that may be obtained LC005914 - Page 3 of 7 1 in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription 2 hormone therapy has already been dispensed during the plan year. 3 (d) To the extent not otherwise prohibited under this section or state or federal law, health 4 plans may apply drug utilization management strategies to prescription drugs covered under 5 subsection (a) of this section. 6 (e) This section does not apply to insurance coverage providing benefits for: 7 (1) Hospital confinement indemnity; 8 (2) Disability income; 9 (3) Accident only; 10 (4) Long-term care; 11 (5) Medicare supplement; 12 (6) Limited benefit health; 13 (7) Specified disease indemnity; 14 (8) Sickness or bodily injury or death by accident or both; and 15 (9) Other limited-benefit policies. 16 SECTION 4. Chapter 27-41 of the General Laws entitled Health Maintenance 17 Organizations is hereby amended by adding thereto the following section: 18 27-41-38.5. Prescription hormone therapy. 19 (a) As used in this section, prescription hormone therapy means all drugs approved by 20 the United States Food and Drug Administration that are used to medically suppress, increase, or 21 replace hormones that the body is not producing at intended levels, as determined by the prescribing 22 provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for 23 administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and 24 glucagon-like peptide-1 receptor agonists. 25 (b) Beginning on the first day of each plan year after January 1, 2027, every individual or 26 group health insurance contract, plan, or policy that provides prescription hormone therapy 27 coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement 28 for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at 29 one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the 30 enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled 31 substance. If the prescription hormone therapy is a controlled substance, the health plan shall 32 provide reimbursement for the maximum refill allowed under state and federal law to be obtained 33 at one time by the enrollee. 34 (c) Nothing in this section prohibits a health plan from limiting refills that may be obtained LC005914 - Page 4 of 7 1 in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription 2 hormone therapy has already been dispensed during the plan year. 3 (d) To the extent not otherwise prohibited under this section or state or federal law, health 4 plans may apply drug utilization management strategies to prescription drugs covered under 5 subsection (a) of this section. 6 (e) This section does not apply to insurance coverage providing benefits for: 7 (1) Hospital confinement indemnity; 8 (2) Disability income; 9 (3) Accident only; 10 (4) Long-term care; 11 (5) Medicare supplement; 12 (6) Limited benefit health; 13 (7) Specified disease indemnity; 14 (8) Sickness or bodily injury or death by accident or both; and 15 (9) Other limited-benefit policies. 16 SECTION 5. Chapter 40-8.4 of the General Laws entitled Health Care for Families is 17 hereby amended by adding thereto the following section: 18 40-8.4-21. Prescription hormone therapy. 19 (a) As used in this section, prescription hormone therapy means all drugs approved by 20 the United States food and drug administration that are used to medically suppress, increase, or 21 replace hormones that the body is not producing at intended levels, as determined by the prescribing 22 provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for 23 administration. Prescription hormone therapy does not include glucagon-like peptide-1 and 24 glucagon-like peptide-1 receptor agonists. 25 (b) Beginning January 1, 2027, the executive office of health and human services (EOHHS) 26 shall provide Medicaid beneficiaries who are prescribed prescription hormone therapy up to three 27 hundred sixty-five (365) days of prescription hormone therapy dispensed as a single prescription. 28 (c) The secretary of the EOHHS shall apply to the United States department of health and 29 human services for any amendment to the state Medicaid plan or for any Medicaid waiver as 30 necessary to implement this section. The secretary of the EOHHS shall submit the Medicaid state 31 plan amendment within ninety (90) days of the effective date of this section. LC005914 - Page 5 of 7 1 SECTION 6. This act shall take effect upon passage. ======== LC005914 ======== LC005914 - Page 6 of 7 EXPLANATION BY THE LEGISLATIVE COUNCIL OF A N A C T RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES *** 1 This act would require the state, and private insurers that cover prescription hormone 2 therapy, to dispense twelve (12) months’ worth of the prescription as a single prescription. 3 This act would take effect upon passage. ======== LC005914 ======== LC005914 - Page 7 of 7