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H 8245Health Insurance

Insurance - Accident and Sickness Insurance Policies

Requires health insurers and Medicaid to cover a 365-day supply of prescription hormone therapy at one time, starting in 2027.

Held for study
Population
Affected
15
Email Legislator
Introduced Mar 6, 2026Committee House Health & Human Services

Plain-English Summary

This legislation mandates that health insurance plans and Medicaid in Rhode Island cover a 12-month (365-day) supply of prescription hormone therapy dispensed at one time, effective January 1, 2027. The bill defines hormone therapy as FDA-approved drugs used to modify hormone levels but explicitly excludes GLP-1 agonists (often used for weight loss or diabetes). While it allows for bulk dispensing, it respects existing laws regarding controlled substances and allows patients or providers to opt for smaller supplies if desired. Insurance companies are still permitted to use drug utilization management strategies.

For younger readers

This new rule helps people who need special medicine called hormone therapy. Sometimes a person's body needs help balancing chemicals called hormones to stay healthy. Starting in the year 2027, this rule says that health insurance companies must let people pick up a full year's worth of this medicine from the pharmacy all at once. This means they won't have to go back to the store every month to get more. This rule does not apply to some specific medicines used for weight loss, but it helps make getting other important medicines much easier.

Who & Where It Applies

Impacted groups
Hormone therapy patientsHealth insurance companiesMedicaid beneficiariesPharmaciesTransgender individuals
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
Amount unknown
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Significantly improves healthcare access for transgender and non-binary individuals by ensuring consistent, long-term access to gender-affirming hormone therapy without monthly administrative hurdles.
  • Reduces logistical and financial barriers for low-income patients and Medicaid beneficiaries who may struggle with transportation to pharmacies or monthly copay accumulations.
  • Strengthens the social safety net by mandating that private insurers and the state Medicaid program prioritize patient stability over corporate dispensing limits.
  • Explicitly excludes GLP-1 receptor agonists, which denies guaranteed bulk access to effective treatments for diabetes and obesity, conditions that disproportionately affect marginalized and poor communities.
  • The implementation date is delayed until 2027, leaving vulnerable populations subject to restrictive dispensing practices for several more years.
  • Allows insurance companies to continue applying "drug utilization management strategies," which could be used as a loophole to deny coverage or create bureaucratic obstacles despite the bulk dispensing mandate.
For Conservatives
  • Explicitly excludes high-cost GLP-1 drugs (like Ozempic) from the mandate, protecting insurance pools and businesses from excessive costs associated with weight-loss trends.
  • Reduces administrative redundancy by allowing for a single transaction per year rather than twelve, potentially lowering processing costs for businesses in the long run.
  • Maintains strict adherence to state and federal laws regarding controlled substances, ensuring that this bill does not weaken drug enforcement policies.
  • Imposes a government mandate on private insurance companies, interfering with the free market and the ability of businesses to structure their own policy benefits.
  • Facilitates easier access to hormone therapies often used in gender transition, which conflicts with traditional social values regarding gender and biology.
  • Expands the scope and potential cost of the state Medicaid program, increasing the burden on taxpayers to fund government-provided healthcare services.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 142 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-50.3. Prescription hormone therapy.

(a) As used in this section, "prescription hormone therapy" means all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels, as determined by the prescribing provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.

(b) Beginning on the first day of each plan year after January 1, 2027, every individual or group health insurance contract, plan, or policy that provides prescription hormone therapy coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled substance. If the prescription hormone therapy is a controlled substance, the health plan shall provide reimbursement for the maximum refill allowed under state and federal law to be obtained at one time by the enrollee.

(c) Nothing in this section prohibits a health plan from limiting refills that may be obtained in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription hormone therapy has already been dispensed during the plan year.

(d) To the extent not otherwise prohibited under this section or state or federal law, health plans may apply drug utilization management strategies to prescription drugs covered under subsection (a) of this section.

(e) This section does not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited-benefit policies.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-42.2. Prescription hormone therapy.

(a) As used in this section, "prescription hormone therapy" means all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels, as determined by the prescribing provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.

(b) Beginning on the first day of each plan year after January 1, 2027, every individual or group health insurance contract, plan, or policy that provides prescription hormone therapy coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled substance. If the prescription hormone therapy is a controlled substance, the health plan shall provide reimbursement for the maximum refill allowed under state and federal law to be obtained at one time by the enrollee.

(c) Nothing in this section prohibits a health plan from limiting refills that may be obtained in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription hormone therapy has already been dispensed during the plan year.

(d) To the extent not otherwise prohibited under this section or state or federal law, health plans may apply drug utilization management strategies to prescription drugs covered under subsection (a) of this section.

(e) This section does not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited-benefit policies.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-23.4. Prescription hormone therapy.

(a) As used in this section, "prescription hormone therapy" means all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels, as determined by the prescribing provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.

(b) Beginning on the first day of each plan year after January 1, 2027, every individual or group health insurance contract, plan, or policy that provides prescription hormone therapy coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled substance. If the prescription hormone therapy is a controlled substance, the health plan shall provide reimbursement for the maximum refill allowed under state and federal law to be obtained at one time by the enrollee.

(c) Nothing in this section prohibits a health plan from limiting refills that may be obtained in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription hormone therapy has already been dispensed during the plan year.

(d) To the extent not otherwise prohibited under this section or state or federal law, health plans may apply drug utilization management strategies to prescription drugs covered under subsection (a) of this section.

(e) This section does not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited-benefit policies.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-38.5. Prescription hormone therapy.

(a) As used in this section, "prescription hormone therapy" means all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels, as determined by the prescribing provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for administration. Prescription hormone therapy shall not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.

(b) Beginning on the first day of each plan year after January 1, 2027, every individual or group health insurance contract, plan, or policy that provides prescription hormone therapy coverage and is delivered, issued for delivery, or renewed in this state shall provide reimbursement for dispensing covered prescription hormone therapy up to three hundred sixty-five (365) days at one time, unless the enrollee requests a smaller supply, the prescribing provider instructs that the enrollee shall receive a smaller supply, or the prescription hormone therapy is a controlled substance. If the prescription hormone therapy is a controlled substance, the health plan shall provide reimbursement for the maximum refill allowed under state and federal law to be obtained at one time by the enrollee.

(c) Nothing in this section prohibits a health plan from limiting refills that may be obtained in the last quarter of the plan year if a three hundred sixty-five (365) day supply of the prescription hormone therapy has already been dispensed during the plan year.

(d) To the extent not otherwise prohibited under this section or state or federal law, health plans may apply drug utilization management strategies to prescription drugs covered under subsection (a) of this section.

(e) This section does not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited-benefit policies.

SECTION 5. Chapter 40-8.4 of the General Laws entitled "Health Care for Families" is hereby amended by adding thereto the following section: 40-8.4-21. Prescription hormone therapy.

(a) As used in this section, "prescription hormone therapy" means all drugs approved by the United States food and drug administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels, as determined by the prescribing provider. Prescription hormone therapy includes, but is not limited to, any necessary supplies for administration. Prescription hormone therapy does not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.

(b) Beginning January 1, 2027, the executive office of health and human services (EOHHS) shall provide Medicaid beneficiaries who are prescribed prescription hormone therapy up to three hundred sixty-five (365) days of prescription hormone therapy dispensed as a single prescription.

(c) The secretary of the EOHHS shall apply to the United States department of health and human services for any amendment to the state Medicaid plan or for any Medicaid waiver as necessary to implement this section. The secretary of the EOHHS shall submit the Medicaid state plan amendment within ninety (90) days of the effective date of this section.

SECTION 6. This act shall take effect upon passage.