The act requires a carrier that offers a health benefit plan (carrier) or a pharmacy benefit management firm that administers or manages contraception coverage under a health benefit plan (PBM) to provide coverage for, and reimburse a prescribing provider or in-network dispensing entity for, the single dispensing or furnishing of contraception intended to last the covered person for a duration of 12 months, as permitted by the covered person's prescription, dispensed or furnished at one time, unless requested otherwise by the covered person.
A carrier or PBM is subject to certain requirements, as applicable, including:
- Allowing coverage of continuous use of contraception, as determined by the prescribing provider;
- A prohibition against implementing utilization management practices that prevent the dispensing of a 12-months' duration of contraception;
- Allowing for alternate prescribed contraception, if medically necessary; and
- Providing coverage for over-the-counter contraception without a prescription and without prior authorization, step therapy, utilization management, or cost sharing.
The act requires carriers to report annually to the division of insurance in the department of regulatory agencies concerning contraception coverage and requires PBM's to provide information to carriers for purposes of this reporting. The act authorizes the commissioner of insurance to promulgate rules regarding the coverage.
APPROVED by Governor May 30, 2023
EFFECTIVE August 7, 2023
NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)