Mandatory Coverage Hormone Replacement Therapy

Second Regular Session Seventy-fifth General Assembly STATE OF COLORADO INTRODUCED HOUSE BILL 26-1122 LLS NO. 26-0559.01 Renee Leone x2695 HOUSE SPONSORSHIP Keltie, SENATE SPONSORSHIP (None), House Committees Senate Committees Health & Human Services A BILL FOR AN ACT CONCERNING MANDATORY HEALTH-CARE COVERAGE FOR HORMONE REPLACEMENT THERAPY FOR WOMEN.

Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.) The bill requires all health benefit plans in the state and the medicaid program to provide coverage for hormone replacement therapy, as prescribed by licensed physicians, for women who are experiencing menopause or perimenopause. Coverage for hormone replacement therapy will be implemented for all large employer health benefit plans issued or renewed in this state Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.

Capital letters or bold & italic numbers indicate new material to be added to existing law. Dashes through the words or numbers indicate deletions from existing law.

on or after January 1, 2027. Coverage for hormone replacement therapy will be implemented for all individual and small group health benefit plans issued or renewed in this state on or after January 1, 2028, as long as the state is not required to defray the cost of the coverage of the hormone replacement therapy. The state medicaid program is required to provide hormone replacement therapy beginning on July 1, 2027.

Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, 10-16-104, add (31) as follows: 10-16-104. Mandatory coverage provisions - applicability rules - definitions.

(31) Hormone replacement therapy - definition - rules.

(a) AS USED IN THIS SUBSECTION (31), UNLESS THE CONTEXT OTHERWISE REQUIRES, "HORMONE REPLACEMENT THERAPY":

(I) MEANS A MEDICAL TREATMENT THAT REPLACES A HORMONE THAT AN INDIVIDUAL'S BODY IS NO LONGER MAKING OR NO LONGER MAKING ENOUGH OF, AS DETERMINED BY A PHYSICIAN LICENSED PURSUANT TO ARTICLE 240 OF TITLE 12; AND

(II) MAY INCLUDE PRESCRIBING A CREAM, AN ORAL MEDICATION, A PELLET MEDICATION, A VAGINAL DEVICE, OR ANOTHER METHOD APPROVED BY THE FDA.

(b) IN ACCORDANCE WITH SUBSECTION (31)(e) OF THIS SECTION, ALL HEALTH BENEFIT PLANS MUST PROVIDE COVERAGE FOR HORMONE REPLACEMENT THERAPY FOR A WOMAN WHO IS EXPERIENCING MENOPAUSE OR PERIMENOPAUSE AS A RESULT OF NATURAL AGING OR ANY OTHER CAUSE, TO BE ADMINISTERED IN THE METHOD, DOSE, AND FREQUENCY PRESCRIBED BY A PHYSICIAN LICENSED PURSUANT TO ARTICLE 240 OF TITLE 12.

(c) A HEALTH BENEFIT PLAN MUST NOT:

(I) DENY OR LIMIT HORMONE REPLACEMENT THERAPY THAT IS PRESCRIBED IN ACCORDANCE WITH GENERALLY ACCEPTED STANDARDS OF CARE FOR THE PRESCRIPTION OF HORMONE REPLACEMENT THERAPY; OR

(II) REQUIRE PRIOR AUTHORIZATION FOR HORMONE REPLACEMENT THERAPY.

(d) THE COMMISSIONER SHALL ADOPT RULES CONSISTENT WITH AND AS NECESSARY TO IMPLEMENT THIS SUBSECTION (31).

(e) (I) ALL LARGE EMPLOYER HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THIS STATE ON OR AFTER JANUARY 1, 2027, SHALL PROVIDE COVERAGE FOR HORMONE REPLACEMENT THERAPY PURSUANT TO THIS SUBSECTION (31).

(II) EXCEPT AS PROVIDED IN SUBSECTION (31)(e)(III) OF THIS SECTION, AND TO THE EXTENT THAT SUCH COVERAGE IS NOT IN ADDITION TO BENEFITS PROVIDED PURSUANT TO THE STATE BENCHMARK PLAN REQUIRED PURSUANT TO 45 CFR 156.111, ALL INDIVIDUAL AND SMALL GROUP HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THIS STATE ON OR AFTER JANUARY 1, 2028, SHALL PROVIDE COVERAGE FOR HORMONE REPLACEMENT THERAPY PURSUANT TO THIS SUBSECTION (31).

(III) SUBSECTION (31)(e)(II) OF THIS SECTION IS INOPERATIVE, AND THE STATE SHALL NOT ASSUME AN OBLIGATION FOR THE COVERAGE REQUIRED PURSUANT TO SUBSECTION (31)(e)(II) OF THIS SECTION, IF:

(A) THE DIVISION DETERMINES THAT THE COVERAGE SPECIFIED IN SUBSECTION (31)(e)(II) OF THIS SECTION REQUIRES STATE DEFRAYAL OF THE COST OF COVERAGE PURSUANT TO A PROVISION OF THE FEDERAL ACT, INCLUDING 42 U.S.C. SEC. 18031 (d)(3)(B) OR A SUCCESSOR PROVISION AND THE IMPLEMENTING REGULATIONS; OR

(B) THE STATE IS OTHERWISE REQUIRED TO DEFRAY THE COST OF COVERAGE REQUIRED PURSUANT TO SUBSECTION (31)(e)(II) OF THIS SECTION.

SECTION 2. In Colorado Revised Statutes, add 25.5-5-332.5 as follows:

authorization - definition.

Hormone replacement therapy - federal SUBJECT TO FEDERAL AUTHORIZATION AND FEDERAL FINANCIAL PARTICIPATION, ON OR AFTER JULY 1, 2027, THE MEDICAL ASSISTANCE PROGRAM SHALL INCLUDE HORMONE REPLACEMENT THERAPY FOR A WOMAN WHO IS EXPERIENCING MENOPAUSE OR PERIMENOPAUSE AS A RESULT OF NATURAL AGING OR ANY OTHER CAUSE, TO BE ADMINISTERED IN THE METHOD, DOSE, AND FREQUENCY PRESCRIBED BY A PHYSICIAN LICENSED PURSUANT TO ARTICLE 240 OF TITLE 12.

(2) AS USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE REQUIRES, "HORMONE REPLACEMENT THERAPY" HAS THE MEANING SET FORTH IN SECTION 10-16-104 (31)(a).

SECTION 3. Act subject to petition - effective date. This act takes effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 12, 2026, if adjournment sine die is on May 13, 2026); except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part will not take effect unless approved by the people at the general election to be held in November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.