Bill Text: VA HB902 | 2024 | Regular Session | Prefiled
Bill Title: Health insurance; coverage for contraceptive drugs and devices.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2024-02-13 - Left in Labor and Commerce [HB902 Detail]
Download: Virginia-2024-HB902-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §38.2-3407.5:1 of the Code of Virginia is amended and reenacted as follows:
§38.2-3407.5:1. Coverage for contraceptives.
A. Each As used in this section:
"Contraceptive device" means any device or non-drug product that has been approved by the FDA to prevent pregnancy.
"Contraceptive drug" means any drug approved by the FDA to prevent pregnancy.
"FDA" means the U.S. Food and Drug Administration.
"Medical need" includes considerations such as severity of side effects, difference in permanence and reversibility of a contraceptive drug or contraceptive device, or an ability to adhere to the appropriate use of such drug or device, as determined by an attending health care provider.
"Therapeutically equivalent version" means a drug or device that has the same clinical effect and safety profile as another drug or device and that meets the criteria for therapeutic equivalence as determined by the FDA.
B. Notwithstanding the
provisions of §38.2-3419, each (i) insurer proposing to
issue individual or group accident and sickness insurance policies providing
hospital, medical and surgical,
or major medical coverage on an expense incurred basis; (ii) corporation
providing individual or group accident and sickness subscription contracts; and
(iii) health maintenance organization providing a health care plan for health care
services, whose policy, contract,
or plan, including any certificate or evidence of coverage issued in connection
with such policy, contract or plan, includes coverage for prescription drugs on
an outpatient basis, shall offer and make
available provide
coverage thereunder for any prescribed contraceptive drug or contraceptive device approved by the United States Food and Drug
Administration for use as a contraceptive available for purchase with or
without a prescription. If the FDA has approved one or more
therapeutically equivalent versions of a contraceptive drug or contraceptive
device, such insurer, corporation, or health maintenance
organization shall provide coverage
of either (i) the original contraceptive drug or contraceptive device or (ii)
at least one therapeutically equivalent version of such drug or device.
B. C. No insurer,
corporation,
or health maintenance organization shall impose upon any person receiving prescription contraceptive
benefits pursuant to this section any (i)
copayment, coinsurance payment, or fee
that is not equally imposed upon all individuals in the same benefit category,
class, coinsurance level or copayment level receiving benefits for prescription
drugs, or (ii)
reduction in allowable reimbursement for prescription drug benefits.
D. Notwithstanding the provisions of subsection C, an insurer, corporation, or health maintenance organization that provides coverage for more than one therapeutically equivalent version of a contraceptive drug or contraceptive device may impose cost-sharing requirements on any such version, provided that at least one therapeutically equivalent version of such contraceptive drug or contraceptive device is available without cost-sharing. However, if a covered individual's health care provider recommends a particular contraceptive drug or contraceptive device for such individual based on a determination of medical need, an insurer, corporation, or health maintenance organization shall provide coverage for the recommended contraceptive drug or contraceptive device without cost-sharing. In such a case, it shall be insufficient for such insurer, corporation, or health maintenance organization to provide coverage for a therapeutically equivalent version of such recommended drug or device without cost-sharing.
E. An insurer, corporation, or health maintenance organization to which the provisions of this section apply shall not impose any burdensome restrictions or delays on the coverage required by this section and shall provide clear, written information about the contraceptive coverage included and excluded from its offered plans available on its website and by mail at the request of a current or potential covered individual.
C. F. The
provisions of subsection A this section shall not be
construed to:
1. Require coverage for prescription coverage benefits in any contract, policy, or plan that does not otherwise provide coverage for prescription drugs; or
2. Preclude the use of closed
formularies, provided, however, that such formularies shall include oral,
implant and injectable contraceptive drugs, intrauterine devices and
prescription barrier methods; or
3.
Require coverage for experimental contraceptive drugs contraceptives not approved by
the United States Food and Drug Administration FDA.
D. G. The
provisions of this section shall not apply to short-term travel, accident-only,
limited or specified disease policies, or contracts designed for issuance to
persons eligible for coverage under Title XVIII of the Social Security Act,
known as Medicare, or any other similar coverage under state or federal
governmental plans, or to short-term nonrenewable policies of not more than six
months' duration.
E. H. The
provisions of this section shall be applicable to contracts, policies, or plans delivered, issued
for delivery,
or renewed in this the Commonwealth on and after July 1, 1997 January 1, 2025.
