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

House of Representatives General Assembly RaisedFile Bill No.

5482427 February Session, 2026 LCOHouse Bill No.

12035482 ReferredHouse toof Representatives, April 7, 2026 The Committee on HUMANHuman SERVICESServices Introducedreported by:through REP.

(HS)GILCHREST ANof ACTthe CONCERNING18th TWELVE-MONTHDist., COVERAGEChairperson FORof CONTRACEPTIONthe ANDCommittee HORMONEon THERAPY.the part of the House, that the bill ought to pass.

AN ACT CONCERNING TWELVE-MONTH COVERAGE FOR CONTRACEPTION AND HORMONE THERAPY.

(b) Each individual and group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2027, that includes coverage for prescription hormone therapy shall provide reimbursement for a twelve-month supply of covered prescription hormone therapy and any necessary supplies for administration dispensedHB5482 at/ oneFile time, unless the (1) insured requests a smaller supply, LCO 1203 1 of 3 Raised Bill No.

5482427 (2)prescribing1 providerHB5482 instructsthatFile theinsuredmustNo. receive asmaller supply, or (3) prescription hormone therapy is a controlled substance.

427 dispensed at one time, unless the (1) insured requests a smaller supply, (2)prescribing provider instructsthat theinsuredmust receive asmaller supply, or (3) prescription hormone therapy is a controlled substance.

(NEW) (Effective January 1, 2027) The Commissioner of Social LCOHB5482 1203/ 2File of 3 Raised Bill No.

5482427 Services,2 toHB5482 theFile extentNo. permissible under federal law, shall provide Medicaid coverage for a twelve-month supply of any prescribed contraceptive drug, device or product approved by the United States Food and Drug Administration and dispensed at one time, unless the Medicaid enrollee or the enrollee's prescribing health care provider requests less than a twelve-month supply of such contraceptive drug, device or product.

427 Services, to the extent permissible under federal law, shall provide Medicaid coverage for a twelve-month supply of any prescribed contraceptive drug, device or product approved by the United States Food and Drug Administration and dispensed at one time, unless the Medicaid enrollee or the enrollee's prescribing health care provider requests less than a twelve-month supply of such contraceptive drug, device or product.

3 New section HS Joint Favorable LCOHB5482 1203/ 3File ofNo. 3

427 3 HB5482 File No.

427 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

None Municipal Impact:

None Explanation The bill requires fully-insured plans to cover one-time, 12-month dispensing of certain covered prescriptions except in specified situations, resulting in no fiscal impact to the state.

HB5482 / File No.

427 4 HB5482 File No.

427 OLR Bill Analysis HB 5482 AN ACT CONCERNING TWELVE-MONTH COVERAGE FOR CONTRACEPTION AND HORMONE THERAPY.

SUMMARY This bill sets requirements related to prescription hormone therapy coverage in private insurance and Medicaid.

Prescription hormone therapy includes all federal Food and Drug Administration (FDA)- approved drugs (excluding GLP-1 drugs) used to medically suppress, increase,orreplacehormonesthatthebodyisnotproducingatintended levels, as determined by the provider.

It requires private health insurers that cover the therapy to reimburse for a 12-month supply and any administration-related supplies dispensed at one time, with certain exceptions.

With certain exceptions, the bill also requires the Department of Social Services (DSS) commissioner to provide Medicaid coverage for a (1) medically necessary 12-month supply of prescription hormone therapy and any administration-related supplies and (2) 12-month supply of any FDA-approved prescription contraception drug, device, or product.

EFFECTIVE DATE:

January 1, 2027 PRIVATE INSURANCE COVERAGE The bill requires individual and group healthinsurance companies to reimburse for a 12-month supply and any necessary administration supplies of a covered prescription hormone therapy dispensed at one time, unless the:

1.

insured requests a smaller supply;

2.

prescribing provider instructs that the insured must receive a HB5482 / File No.

427 5 HB5482 File No.

427 smaller supply;

or 3.

prescription hormone therapy is a controlled substance, in which case the health plan must reimburse for the maximum refills allowed for the insured under state and federal law.

The requirement applies to each individual or group health insurer, health care center (HMO), fraternal benefit society, health service corporation, medical service corporation, or other entity that delivers, issues, renews, amends, or continues a health insurance policy in the state on or after January 1, 2027, that covers (1) basic hospital expenses, (2) basic medical-surgical expenses, (3) major medical expenses, or (4) hospital or medical services.

Because of the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

The bill specifies that it does not prohibit a health plan from limiting refills in the last quarter of the plan year if a 12-month supply has already been dispensed in the plan year.

To the extent state and federal law allows, the bill allows plans to apply drug utilization strategies to prescription hormone therapies.