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S 2254Health Insurance

Insurance - Accident and Sickness Insurance Policies

Mandates health insurance coverage for all FDA-approved contraceptives, including over-the-counter options, with no out-of-pocket costs for patients.

Introduced37 Yea0 Nay1 Not voting
Population
Affected
72
Introduced Jan 23, 2026Committee Senate Health & Human Services

Plain-English Summary

This legislation mandates that individual and group health insurance plans, including Medicaid and those provided by non-profit hospital service corporations, cover all FDA-approved prescription and over-the-counter contraceptive drugs, devices, and products without cost-sharing (deductibles or copayments). It requires coverage for voluntary sterilization and related clinical services. The bill allows for the dispensing of up to a 12-month supply of contraceptives at one time. While it maintains exemptions for religious employers, it establishes strict regulatory oversight, requiring the health insurance commissioner to conduct compliance reviews and hold stakeholder meetings to ensure insurers adhere to these requirements starting January 1, 2027.

For younger readers

This new rule helps people get medicine and other items that prevent pregnancy. It tells health insurance companies that they must pay for these items so that people do not have to pay extra money, like a copay, at the pharmacy. It allows people to pick up enough medicine for a whole year at one time instead of going to the store every month. The government will check on the insurance companies to make sure they are following the rules and treating everyone fairly.

Who & Where It Applies

Impacted groups
Women and individuals capable of pregnancyHealth Insurance CompaniesMedicaid RecipientsReligious EmployersPharmacists
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
Amount unknown
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Eliminates financial barriers to reproductive healthcare by removing cost-sharing (copays and deductibles) for all FDA-approved contraceptives, including over-the-counter options, which disproportionately benefits low-income individuals.
  • Enhances reproductive autonomy by mandating coverage for a 12-month supply of contraceptives at one time, ensuring consistent access and reducing the risk of unintended pregnancy due to gaps in pharmacy visits.
  • Mandates an inclusive stakeholder process that specifically requires the inclusion of representatives for youth, low-income people, and communities of color in the implementation and rulemaking process.
  • Maintains a "religious employer" exemption, allowing certain organizations to deny contraceptive coverage to their employees based on the employer's religious tenets, which restricts access for workers in those institutions.
  • Explicitly excludes coverage mandate for RU 486 (mifepristone), creating a distinction that leaves abortion medication less protected than preventative contraception.
  • Delays the implementation of the insurance mandates until January 1, 2027, leaving a significant gap of time where current barriers to access will remain in place.
For Conservatives
  • Preserves religious freedom by explicitly maintaining an exemption that allows religious employers to exclude contraceptive coverage that violates their bona fide religious tenets.
  • Explicitly states that the bill does not mandate or require coverage for the prescription drug RU 486, ensuring the legislation is not used to fund medication abortion.
  • Includes a carve-out for high-deductible health plans associated with Health Savings Accounts (HSAs) to ensure they remain compliant with federal tax laws regarding minimum deductibles.
  • Imposes heavy government regulations on private businesses and insurance carriers by mandating coverage for over-the-counter products without cost-sharing, which will likely drive up premiums for all ratepayers.
  • Interferes with the free market by prohibiting insurers from using medical management techniques or utilization controls, such as limiting supplies or requiring prescriptions for over-the-counter items.
  • Expands the bureaucracy by mandating "stakeholder meetings" with specific identity groups (youth, communities of color) and requiring annual reports and random reviews, increasing administrative costs.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 393 additions · 33 deletions

SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident and Sickness Insurance Policies" is hereby amended to read as follows: 27-18-57. FDA approved prescription contraceptive drugs and devices.

(a) Every individual or group health insurance contract, plan, or policy issued pursuant to this title that provides prescription coverage and is delivered, issued for delivery, or renewed, amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription all of the following services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.

(1) All FDA-approved contraceptive drugs, devices, and other products. The following applies to this coverage:

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or product, the contract shall include either the original FDA-approved contraceptive drug, device, or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same definition as that set forth by the FDA;

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or blanket policy shall provide coverage for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based on the determination of the health care provider, without cost-sharing; and

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical management restrictions;

(2) Voluntary sterilization procedures;

(3) Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling; and

(4) Follow-up services related to the drugs, devices, products, and procedures covered under this section, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.

(b) A group or blanket policy subject to this section shall not impose a deductible, coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant to this section. For a qualifying high-deductible health plan for a health savings account, the carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not impose utilization control or other forms of medical management limiting the supply of FDA- approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less than a twelve (12) month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.

(c) Except as otherwise authorized under this section, a group or blanket policy shall not impose any restrictions or delays on the coverage required under this section.

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered spouse or domestic partner and covered non-spouse dependents. (b)(e) Notwithstanding any other provision of this section, any insurance company may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not apply to contraceptive services or procedures provided for purposes other than contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. (c)(f) As used in this section, “religious employer” means an employer that is a “church or a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. (d)(g) 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. (e)(h) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons. (f)(i) Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the course of the twelve (12) month period at the discretion of the prescriber.

(j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in accordance with § 27-18-20. The office of the health insurance commissioner ("commissioner") may base its determinations on findings from onsite surveys, enrollee or other complaints, financial status, or any other source.

(k) The commissioner shall monitor plan compliance in accordance with this section and shall adopt rules and regulations for the implementation of this section, including the following:

(1) In addition to any requirements under state administrative procedures, the commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations that include health care service plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-income people, and communities of color, and other interested parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. The commissioner shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings shall be open to the public.

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to ensure compliance with this section.

(3) The commissioner shall submit an annual report to the general assembly and any other appropriate entity with its findings from the random compliance reviews detailed in this section and any other compliance or implementation efforts. This report shall be made available to the public on the commissioner's website.

SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit Hospital Service Corporations" is hereby amended to read as follows: 27-19-48. FDA approved prescription contraceptive drugs and devices.

(a) Every individual or group health insurance contract, plan, or policy issued pursuant to this title that provides prescription coverage and is delivered, issued for delivery, or renewed, amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription all of the following services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.

(1) All FDA-approved contraceptive drugs, devices, and other products. The following applies to this coverage:

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or product, the contract shall include either the original FDA-approved contraceptive drug, device, or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same definition as that set forth by the FDA;

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or blanket policy shall provide coverage for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based on the determination of the health care provider, without cost-sharing; and

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical management restrictions;

(2) Voluntary sterilization procedures;

(3) Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling; and

(4) Follow-up services related to the drugs, devices, products, and procedures covered under this section, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.

(b) A group or blanket policy subject to this section shall not impose a deductible, coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant to this section. For a qualifying high-deductible health plan for a health savings account, the carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not impose utilization control or other forms of medical management limiting the supply of FDA- approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less than a twelve (12) month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.

(c) Except as otherwise authorized under this section, a group or blanket policy shall not impose any restrictions or delays on the coverage required under this section.

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered spouse or domestic partner and covered non-spouse dependents. (b)(e) Notwithstanding any other provision of this section, any hospital service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not apply to contraceptive services or procedures provided for purpose other than contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. (c)(f) As used in this section, “religious employer” means an employer that is a “church or a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. (d)(g) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons. (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the course of the twelve (12) month period at the discretion of the prescriber.

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in accordance with § 27-19-38. The commissioner may base its determinations on findings from onsite surveys, enrollee or other complaints, financial status, or any other source.

(j) The commissioner shall monitor plan compliance in accordance with this section and shall adopt rules and regulations for the implementation of this section, including the following:

(1) In addition to any requirements under state administrative procedures, the commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations that include health care service plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-income people, and communities of color, and other interested parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and stakeholder meetings shall be open to the public.

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to ensure compliance with this section.

(3) The commissioner shall submit an annual report to the general assembly and any other appropriate entity with its findings from the random compliance reviews detailed in this section and any other compliance or implementation efforts. This report shall be made available to the public on the commissioner's website.

SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit Medical Service Corporations" is hereby amended to read as follows: 27-20-43. FDA approved prescription contraceptive drugs and devices.

(a) Every individual or group health insurance contract, plan, or policy issued pursuant to this title that provides prescription coverage and is delivered, issued for delivery, or renewed, amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription all of the following services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.

(1) All FDA-approved contraceptive drugs, devices and other products. The following applies to this coverage:

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or product, the contract shall include either the original FDA-approved contraceptive drug, device, or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same definition as that set forth by the FDA;

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or blanket policy shall provide coverage for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based on the determination of the health care provider, without cost-sharing; and

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical management restrictions;

(2) Voluntary sterilization procedures;

(3) Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling; and

(4) Follow-up services related to the drugs, devices, products, and procedures covered under this section, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.

(b) A group or blanket policy subject to this section shall not impose a deductible, coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant to this section. For a qualifying high-deductible health plan for a health savings account, the carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not impose utilization control or other forms of medical management limiting the supply of FDA- approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less than a twelve (12) month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.

(c) Except as otherwise authorized under this section, a group or blanket policy shall not impose any restrictions or delays on the coverage required under this section.

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered spouse or domestic partner and covered non-spouse dependents. (b)(e) Notwithstanding any other provision of this section, any medical service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer’s bona fide religious tenets. The exclusion from coverage under this subsection, shall not apply to contraceptive services or procedures provided for purposes other than contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. (c)(f) As used in this section, “religious employer” means an employer that is a “church or a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. (d)(g) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons. (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the course of the twelve (12) month period at the discretion of the prescriber.

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in accordance with § 27-20-33. The commissioner may base its determinations on findings from onsite surveys, enrollee or other complaints, financial status, or any other source.

(j) The commissioner shall monitor plan compliance in accordance with this section and shall adopt rules and regulations for the implementation of this section, including the following:

(1) In addition to any requirements under state administrative procedures, the commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations that include health care service plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-income people, and communities of color, and other interested parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and stakeholder meetings shall be open to the public.

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to ensure compliance with this section.

(3) The commissioner shall submit an annual report to the general assembly and any other appropriate entity with its findings from the random compliance reviews detailed in this section and any other compliance or implementation efforts. This report shall be made available to the public on the commissioner's website.

SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health Maintenance Organizations" is hereby amended to read as follows: 27-41-59. FDA approved prescription contraceptive drugs and devices.

(a) Every individual or group health insurance contract, plan, or policy issued pursuant to this title that provides prescription coverage and is delivered, issued for delivery, or renewed, amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription; provided, all of the following services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.

(1) All FDA-approved contraceptive drugs, devices, and other products. The following applies to this coverage:

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or product, the contract shall include either the original FDA-approved contraceptive drug, device, or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same definition as that set forth by the FDA;

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or blanket policy shall provide coverage for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based on the determination of the health care provider, without cost-sharing; and

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical management restrictions;

(2) Voluntary sterilization procedures;

(3) Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling; and

(4) Follow-up services related to the drugs, devices, products, and procedures covered under this section, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.

(b) A group or blanket policy subject to this section shall not impose a deductible, coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant to this section. For a qualifying high-deductible health plan for a health savings account, the carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not impose utilization control or other forms of medical management limiting the supply of FDA- approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less than a twelve (12) month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.

(c) Except as otherwise authorized under this section, a group or blanket policy shall not impose any restrictions or delays on the coverage required under this section.

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered spouse or domestic partner and covered non-spouse dependents. (b)(e) Notwithstanding any other provision of this section, any health maintenance corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not apply to contraceptive services or procedures provided for purposes other than contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. (c)(f) As used in this section, “religious employer” means an employer that is a “church or a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. (d)(g) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons. (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the course of the twelve (12) month period at the discretion of the prescriber.

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in accordance with § 27-41-21. The commissioner may base its determinations on findings from onsite surveys, enrollee or other complaints, financial status, or any other source.

(j) The commissioner shall monitor plan compliance in accordance with this section and shall adopt rules and regulations for the implementation of this section, including the following:

(1) In addition to any requirements under state administrative procedures, the commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations that include health care service plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-income people, and communities of color, and other interested parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and stakeholder meetings shall be open to the public.

(2) The commissioner shall conduct random reviews of each plan and its subcontractors to ensure compliance with this section.

(3) The commissioner shall submit an annual report to the general assembly and any other appropriate entity with its findings from the random compliance reviews detailed in this section and any other compliance or implementation efforts. This report shall be made available to the public on the commissioner's website.

SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby amended by adding thereto the following section: 40-8-33. F.D.A. approved prescription contraceptive drugs and devices.

(a) Every individual or group health insurance contract, plan, or policy issued pursuant to this chapter that is delivered, issued for delivery, renewed, amended or effective in this state on or after January 1, 2027 shall provide coverage for all of the following services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.

(1) All FDA-approved contraceptive drugs, devices, and other products. The following applies to this coverage:

(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or product, the contract shall include either the original FDA-approved contraceptive drug, device, or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same definition as that set forth by the FDA;

(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or blanket policy shall provide coverage for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based on the determination of the health care provider, without cost-sharing; and

(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical management restrictions;

(2) Voluntary sterilization procedures;

(3) Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient education, referrals, and counseling; and

(4) Follow-up services related to the drugs, devices, products, and procedures covered under this section, including, but not limited to, management of side effects, counseling for continued adherence, and device insertion and removal.

(b) A group or blanket policy subject to this section shall not impose a deductible, coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant to this section. For a qualifying high-deductible health plan for a health savings account, the carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not impose utilization control or other forms of medical management limiting the supply of FDA- approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less than a twelve (12) month supply, and shall not require an enrollee to make any formal request for such coverage other than a pharmacy claim.

(c) Except as otherwise authorized under this section, a group or blanket policy shall not impose any restrictions or delays on the coverage required under this section.

(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered spouse or domestic partner and covered non-spouse dependents.

(e) Notwithstanding any other provision of this section, any health maintenance corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer's bona fide religious tenets. The exclusion from coverage under this subsection shall not apply to contraceptive services or procedures provided for purposes other than contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause.

(f) As used in this section, "religious employer" means an employer that is a "church or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

(g) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.

(h) Beginning on the first day of each plan year after April 1, 2024, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the course of the twelve (12) month period at the discretion of the prescriber.

(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in accordance with § 40-8-9. The executive office of health and human services may base its determinations on findings from onsite surveys, enrollee or other complaints, financial status, or any other source.

(j) The executive office of health and human services shall monitor plan compliance in accordance with this section and shall adopt and regulations rules for the implementation of this section, including the following:

(1) In addition to any requirements under state administrative procedures, the executive office of health and human services shall engage in a stakeholder process prior to the adoption of rules and regulations that include health care service plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-income people, and communities of color, and other interested parties. The executive office of health and human services shall hold stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. The executive office of health and human services shall provide notice of stakeholder meetings on the executive office of health and human services' website, and stakeholder meetings shall be open to the public.

(2) The executive office of health and human services shall conduct random reviews of each plan and its subcontractors to ensure compliance with this section.

(3) The executive office of health and human services shall submit an annual report to the general assembly and any other appropriate entity with its findings from the random compliance reviews detailed in this section and any other compliance or implementation efforts. This report shall be made available to the public on the executive office of health and human services' website.

SECTION 6. This act shall take effect upon passage.