2026 -- S 2863

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LC005388

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2026

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Senators Murray, Valverde, Gu, Urso, DiMario, Mack, Euer, Lauria,
Ujifusa, and Vargas

     Date Introduced: March 04, 2026

     Referred To: Senate 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:

     27-18-50.3. 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

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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

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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

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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.

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     SECTION 6. This act shall take effect upon passage.

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LC005388

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require the state, and private insurers that cover prescription hormone

therapy, to dispense twelve (12) months’ worth of the prescription as a single prescription.

     This act would take effect upon passage.

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LC005388

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