2025 -- H 5626

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LC002031

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Speakman, Knight, Boylan, Donovan, Fogarty, Spears,
Cotter, Carson, Tanzi, and Alzate

     Date Introduced: February 26, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following section:

     27-18-57.1. Coverage for contraceptive drugs, devices or therapeutic equivalent.

     (a) Notwithstanding any other provision of this chapter, any health insurance contract, plan,

or policy delivered or issued for delivery or renewed in this state, except contracts providing

supplemental coverage to Medicare or other governmental programs, shall provide coverage for

the following services and contraceptive methods:

     (1) United States Food and Drug Administration (FDA) approved contraceptive drugs,

devices and other products; provided, however, that coverage shall not be required for male

condoms or FDA-approved oral contraceptive drugs that do not have a therapeutic equivalent; and

provided further, that:

     (i) If the FDA has approved one or more therapeutic equivalents of a contraceptive drug,

device or product, the office of the health insurance commissioner shall not be required to include

all such therapeutically equivalent versions in its formulary as long as at least one is included and

covered without cost-sharing and in accordance with this section; and

     (ii) If there is a therapeutic equivalent of a drug, device or other product for an FDA-

approved contraceptive method, the insurer may provide coverage for more than one drug, device

or other product and may impose cost-sharing requirements as long as at least one drug, device or

other product for that method is available without cost-sharing; provided, however, that if an

individual’s provider recommends a particular FDA-approved contraceptive based on a medical

determination with respect to that individual, regardless of whether the contraceptive has a

therapeutic equivalent, the insurer shall provide coverage for the prescribed contraceptive drug,

device or product without cost-sharing;

     (2) FDA-approved emergency contraception available over-the-counter, whether with a

prescription or dispensed consistent with the requirements of current law;

     (3) Prescription contraceptives intended to last:

     (i) For not more than a three (3) month period for the first time the prescription

contraceptive is dispensed to the covered person; and

     (ii) For not more than a twelve (12) month period for any subsequent dispensing of the

same prescription, which may be dispensed all at once or over the course of the twelve (12) month

period, regardless of whether the covered person was enrolled in a plan or policy under this chapter

at the time the prescription contraceptive was first dispensed; provided, however, that the insured

may not fill more than one twelve (12) month prescription in a single dispensing per plan year;

     (4) Voluntary female sterilization procedures;

     (5) Patient education and counseling on contraception; and

     (6) Follow-up services related to the drugs, devices, products and procedures covered under

this subsection including, but not limited to, management of side effects, counseling for continued

adherence and device insertion and removal.

     (b) For purposes of this section, the following words shall have the following meanings

unless the context clearly requires otherwise:

     (1) “Provider” means an individual or facility licensed, certified, or otherwise authorized

or permitted by law to administer health care in the ordinary course of business or professional

practice acting within the scope of their license.

     (2) “Therapeutic equivalent” means a contraceptive drug, device, or product that is:

     (i) Approved by the FDA as safe and effective;

     (ii) Pharmaceutically equivalent to another contraceptive drug, device, or product in that it

contains an identical amount of the same active drug ingredient in the same dosage form and route

of administration and meets compendial or other applicable standards of strength, quality, purity,

and identity; and

     (iii) Assigned the same therapeutic equivalence code as another contraceptive drug, device

or product by the FDA.

     (c) Coverage provided under this section shall not be subject to any deductible,

coinsurance, copayment, or other cost-sharing requirement, except as otherwise required under

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federal law. Coverage offered under this section shall not impose unreasonable restrictions or

delays in the coverage; provided, however, that reasonable medical management techniques may

be applied to coverage within a method category, as defined by the FDA, but not across types of

methods.

     (d) Benefits for an enrollee under this section shall be the same for the enrollee’s covered

spouse and covered dependents.

     (e) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, products, and procedures as prescribed by a provider for reasons other than contraceptive

purposes including, but not limited to, decreasing the risk of ovarian cancer, eliminating symptoms

of menopause or providing contraception that is necessary to preserve the life or health of the

enrollee or the enrollee’s covered spouse or covered dependents.

     (f) The office of the health insurance commissioner shall ensure plan compliance with this

section.

     (g) Nothing in this section shall be construed to require insurers to cover experimental or

investigational treatments.

     SECTION 2. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-43.1. Coverage for contraceptive drugs, devices or therapeutic equivalent.

     (a) Notwithstanding any other provision of this chapter, any health insurance contract, plan,

or policy delivered or issued for delivery or renewed in this state, except contracts providing

supplemental coverage to Medicare or other governmental programs, shall provide coverage for

the following services and contraceptive methods:

     (1) United States Food and Drug Administration (FDA) approved contraceptive drugs,

devices and other products; provided, however, that coverage shall not be required for male

condoms or FDA-approved oral contraceptive drugs that do not have a therapeutic equivalent; and

provided further, that:

     (i) If the FDA has approved one or more therapeutic equivalents of a contraceptive drug,

device or product, the office of the health insurance commissioner shall not be required to include

all such therapeutically equivalent versions in its formulary as long as at least one is included and

covered without cost-sharing and in accordance with this section; and

     (ii) If there is a therapeutic equivalent of a drug, device or other product for an FDA-

approved contraceptive method, the insurer may provide coverage for more than one drug, device

or other product and may impose cost-sharing requirements as long as at least one drug, device or

other product for that method is available without cost-sharing; provided, however, that if an

LC002031 - Page 3 of 8

individual’s provider recommends a particular FDA-approved contraceptive based on a medical

determination with respect to that individual, regardless of whether the contraceptive has a

therapeutic equivalent, the insurer shall provide coverage for the prescribed contraceptive drug,

device or product without cost-sharing;

     (2) FDA-approved emergency contraception available over-the-counter, whether with a

prescription or dispensed consistent with the requirements of current law;

     (3) Prescription contraceptives intended to last:

     (i) For not more than a three (3) month period for the first time the prescription

contraceptive is dispensed to the covered person; and

     (ii) For not more than a twelve (12) month period for any subsequent dispensing of the

same prescription, which may be dispensed all at once or over the course of the twelve (12) month

period, regardless of whether the covered person was enrolled in a plan or policy under this chapter

at the time the prescription contraceptive was first dispensed; provided, however, that the insured

may not fill more than one twelve (12) month prescription in a single dispensing per plan year;

     (4) Voluntary female sterilization procedures;

     (5) Patient education and counseling on contraception; and

     (6) Follow-up services related to the drugs, devices, products and procedures covered under

this subsection including, but not limited to, management of side effects, counseling for continued

adherence and device insertion and removal.

     (b) For purposes of this section, the following words shall have the following meanings

unless the context clearly requires otherwise:

     (1) “Provider” means an individual or facility licensed, certified, or otherwise authorized

or permitted by law to administer health care in the ordinary course of business or professional

practice acting within the scope of their license.

     (2) “Therapeutic equivalent” means a contraceptive drug, device, or product that is:

     (i) Approved by the FDA as safe and effective;

     (ii) Pharmaceutically equivalent to another contraceptive drug, device, or product in that it

contains an identical amount of the same active drug ingredient in the same dosage form and route

of administration and meets compendial or other applicable standards of strength, quality, purity,

and identity; and

     (iii) Assigned the same therapeutic equivalence code as another contraceptive drug, device

or product by the FDA.

     (c) Coverage provided under this section shall not be subject to any deductible,

coinsurance, copayment, or other cost-sharing requirement, except as otherwise required under

LC002031 - Page 4 of 8

federal law. Coverage offered under this section shall not impose unreasonable restrictions or

delays in the coverage; provided, however, that reasonable medical management techniques may

be applied to coverage within a method category, as defined by the FDA, but not across types of

methods.

     (d) Benefits for an enrollee under this section shall be the same for the enrollee’s covered

spouse and covered dependents.

     (e) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, products, and procedures as prescribed by a provider for reasons other than contraceptive

purposes including, but not limited to, decreasing the risk of ovarian cancer, eliminating symptoms

of menopause or providing contraception that is necessary to preserve the life or health of the

enrollee or the enrollee’s covered spouse or covered dependents.

     (f) The office of the health insurance commissioner shall ensure plan compliance with this

section.

     (g) Nothing in this section shall be construed to require insurers to cover experimental or

investigational treatments.

     SECTION 3. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-59.1. Coverage for contraceptive drugs, devices or therapeutic equivalent.

     (a) Notwithstanding any other provision of this chapter, any health insurance contract, plan,

or policy delivered or issued for delivery or renewed in this state, except contracts providing

supplemental coverage to Medicare or other governmental programs, shall provide coverage for

the following services and contraceptive methods:

     (1) United States Food and Drug Administration (FDA) approved contraceptive drugs,

devices and other products; provided, however, that coverage shall not be required for male

condoms or FDA-approved oral contraceptive drugs that do not have a therapeutic equivalent; and

provided further, that:

     (i) If the FDA has approved one or more therapeutic equivalents of a contraceptive drug,

device or product, the office of the health insurance commissioner shall not be required to include

all such therapeutically equivalent versions in its formulary as long as at least one is included and

covered without cost-sharing and in accordance with this section; and

     (ii) If there is a therapeutic equivalent of a drug, device or other product for an FDA-

approved contraceptive method, the insurer may provide coverage for more than one drug, device

or other product and may impose cost-sharing requirements as long as at least one drug, device or

other product for that method is available without cost-sharing; provided, however, that if an

LC002031 - Page 5 of 8

individual’s provider recommends a particular FDA-approved contraceptive based on a medical

determination with respect to that individual, regardless of whether the contraceptive has a

therapeutic equivalent, the insurer shall provide coverage for the prescribed contraceptive drug,

device or product without cost-sharing;

     (2) FDA-approved emergency contraception available over-the-counter, whether with a

prescription or dispensed consistent with the requirements of current law;

     (3) Prescription contraceptives intended to last:

     (i) For not more than a three (3) month period for the first time the prescription

contraceptive is dispensed to the covered person; and

     (ii) For not more than a twelve (12) month period for any subsequent dispensing of the

same prescription, which may be dispensed all at once or over the course of the twelve (12) month

period, regardless of whether the covered person was enrolled in a plan or policy under this chapter

at the time the prescription contraceptive was first dispensed; provided, however, that the insured

may not fill more than one twelve (12) month prescription in a single dispensing per plan year;

     (4) Voluntary female sterilization procedures;

     (5) Patient education and counseling on contraception; and

     (6) Follow-up services related to the drugs, devices, products and procedures covered under

this subsection including, but not limited to, management of side effects, counseling for continued

adherence and device insertion and removal.

     (b) For purposes of this section, the following words shall have the following meanings

unless the context clearly requires otherwise:

     (1) “Provider” means an individual or facility licensed, certified, or otherwise authorized

or permitted by law to administer health care in the ordinary course of business or professional

practice acting within the scope of their license.

     (2) “Therapeutic equivalent” means a contraceptive drug, device, or product that is:

     (i) Approved by the FDA as safe and effective;

     (ii) Pharmaceutically equivalent to another contraceptive drug, device, or product in that it

contains an identical amount of the same active drug ingredient in the same dosage form and route

of administration and meets compendial or other applicable standards of strength, quality, purity,

and identity; and

     (iii) Assigned the same therapeutic equivalence code as another contraceptive drug, device

or product by the FDA.

     (c) Coverage provided under this section shall not be subject to any deductible,

coinsurance, copayment, or other cost-sharing requirement, except as otherwise required under

LC002031 - Page 6 of 8

federal law. Coverage offered under this section shall not impose unreasonable restrictions or

delays in the coverage; provided, however, that reasonable medical management techniques may

be applied to coverage within a method category, as defined by the FDA, but not across types of

methods.

     (d) Benefits for an enrollee under this section shall be the same for the enrollee’s covered

spouse and covered dependents.

     (e) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, products, and procedures as prescribed by a provider for reasons other than contraceptive

purposes including, but not limited to, decreasing the risk of ovarian cancer, eliminating symptoms

of menopause or providing contraception that is necessary to preserve the life or health of the

enrollee or the enrollee’s covered spouse or covered dependents.

     (f) The office of the health insurance commissioner shall ensure plan compliance with this

section.

     (g) Nothing in this section shall be construed to require insurers to cover experimental or

investigational treatments.

     SECTION 4. This act shall take effect on January 1, 2026.

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LC002031

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would mandate health insurance coverage for at least one FDA-approved

contraceptive drug, device or therapeutic equivalent, emergency contraception available over-the-

counter, as well as voluntary female sterilization procedures; patient education and counseling on

contraception; and follow-up services related to the drugs, devices, products and procedures.

     This act would take effect on January 1, 2026.

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LC002031

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