Connecticut HB 5482: AN ACT CONCERNING TWELVE-MONTH COVERAGE FOR CONTRACEPTION AND HORMONE THERAPY.

Bill Text

LCO 1203 
 
1 of 3 
  
General Assembly  
Raised Bill No. 5482  
February Session, 2026 
 
LCO No. 1203 
 
 
Referred to Committee on HUMAN SERVICES  
 
 
Introduced by:  
(HS)  
 
 
 
AN ACT CONCERNING TWELVE-MONTH COVERAGE FOR 
CONTRACEPTION AND HORMONE THERAPY.  
Be  it  enacted  by  the  Senate  and  House  of  Representatives  in  General 
Assembly convened: 
 
Section 1. (NEW) (Effective January 1, 2027) (a) As used in this section, 1 
"prescription  hormone  therapy"  means  all  drugs  approved  by  the 2 
United States Food and Drug Administration that are used to medically 3 
suppress, increase or replace hormones that the body is not producing 4 
at   intended   levels,   as   determined   by   the   prescribing   provider. 5 
"Prescription hormone therapy" does not include glucagon-like peptide-6 
1 and glucagon-like peptide-1 receptor agonists. 7 
(b)  Each  individual  and  group  health  insurance  policy  providing 8 
coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) 9 
of section 38a-469 of the general statutes, delivered, issued for delivery, 10 
renewed, amended or continued in this state on or after January 1, 2027, 11 
that includes coverage for prescription hormone therapy shall provide 12 
reimbursement  for  a  twelve-month  supply  of  covered  prescription 13 
hormone   therapy   and   any   necessary   supplies   for   administration 14 
dispensed at one time, unless the (1) insured requests a smaller supply, 15 

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(2) prescribing provider instructs that the insured must receive a smaller 16 
supply, or (3) prescription hormone therapy is a controlled substance. If 17 
the prescription hormone therapy is a controlled substance, the health 18 
plan  shall  provide  reimbursement  for  the  maximum  refills  allowed 19 
under state and federal law to be obtained at one time by the insured. 20 
(c) Nothing in this section prohibits a health plan from limiting refills 21 
that  may  be  obtained  in  the  last  quarter  of  the  plan  year  if  a  twelve-22 
month  supply  of  the  prescription  hormone  therapy  has  already  been 23 
dispensed during the plan year. To the extent not otherwise prohibited 24 
under  state  or  federal  law,  health  plans  may  apply  drug  utilization 25 
management strategies to prescription drugs covered under this section. 26 
Sec. 2. (NEW) (Effective January 1, 2027) (a) As used in this section, (1) 27 
"medically necessary" has the same meaning as provided in section 17b-28 
259b  of  the  general  statutes;  and  (2)  "prescription  hormone  therapy" 29 
means  all  drugs  approved  by  the  United  States  Food  and  Drug 30 
Administration that are used to medically suppress, increase or replace 31 
hormones   that   the   body   is   not   producing   at   intended   levels,   as 32 
determined   by   the   prescribing   provider. "Prescription   hormone 33 
therapy" does  not  include  glucagon-like  peptide-1  and  glucagon-like 34 
peptide-1 receptor agonists. 35 
(b)  The  Commissioner  of  Social  Services,  to  the  extent  permissible 36 
under  federal  law,  shall  provide  Medicaid  coverage  for  a  medically 37 
necessary  twelve-month  supply  of  prescription  hormone  therapy  and 38 
any necessary supplies for administration dispensed at one time, unless 39 
the  (1)  enrollee  requests  a  smaller  supply,  (2)  prescribing  provider 40 
instructs   that   the   enrollee   must   receive   a   smaller   supply,   or   (3) 41 
prescription   hormone   therapy   is   a   controlled   substance.   If   the 42 
prescription    hormone    therapy    is    a    controlled    substance,    the 43 
commissioner shall provide Medicaid coverage for the maximum refills 44 
allowed under state and federal law to be obtained at one time by the 45 
Medicaid enrollee. 46 
Sec. 3. (NEW) (Effective January 1, 2027) The Commissioner of Social 47 

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Services,  to  the  extent  permissible  under  federal  law,  shall  provide 48 
Medicaid   coverage   for   a   twelve-month   supply   of   any   prescribed 49 
contraceptive  drug,  device  or  product  approved  by  the  United  States 50 
Food  and  Drug  Administration  and  dispensed  at  one  time,  unless  the 51 
Medicaid  enrollee  or  the  enrollee's  prescribing  health  care  provider 52 
requests  less  than  a  twelve-month  supply  of  such  contraceptive  drug, 53 
device or product. 54 
This act shall take effect as follows and shall amend the following 
sections: 
 
Section 1 
January 1, 2027 
New section 
Sec. 2 
January 1, 2027 
New section 
Sec. 3 
January 1, 2027 
New section 
 
HS Joint Favorable