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Bill > LD163

ME LD163

An Act to Require Health Insurance Coverage for Federally Approved Nonprescription Oral Hormonal Contraceptives and Nonprescription Emergency Contraceptives

summary

Introduced
01/14/2025
In Committee
01/14/2025
Crossed Over
05/13/2025
Passed
05/14/2025
Dead

Introduced Session

Potential new amendment
132nd Legislature

Bill Summary

This bill expands the requirements in current law for coverage of contraceptives to include nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives approved by the federal Food and Drug Administration. The bill provides that a prescription is not required for insurance coverage for nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives and requires insurers to establish mechanisms to ensure that an enrollee who purchases a nonprescription oral hormonal contraceptive or nonprescription emergency contraceptive at a pharmacy has the option to make the purchase pursuant to a standing order issued for billing purposes without a payment required at the point of sale or to make the purchase with a payment at the point of sale and submit a claim for reimbursement to the insurer. The requirements apply beginning January 1, 2026. The bill requires health insurance carriers to notify enrollees, at least annually, of the coverage requirements for contraceptive supplies and the procedures an enrollee must follow to access coverage for nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives at a pharmacy without an out-of-pocket cost at the point of sale or by submitting a claim for reimbursement. The bill also authorizes the Department of Professional and Financial Regulation, Bureau of Insurance to adopt rules to implement the provisions and also requires the bureau to monitor implementation by health insurance carriers and to report to the joint standing committee of the Legislature having jurisdiction over health coverage, insurance and financial services matters no later than November 4, 2026.

AI Summary

This bill expands health insurance coverage requirements to include nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives approved by the FDA. Starting January 1, 2026, health insurance policies must cover these over-the-counter (OTC) contraceptives without any out-of-pocket costs, similar to prescription contraceptives. The bill requires insurers to provide two purchasing options for OTC contraceptives at pharmacies: either obtaining the product at the point of sale without any upfront payment or paying out-of-pocket and submitting a claim for reimbursement. No prescription will be required to obtain these nonprescription contraceptives, and insurers must cover a 12-month supply. The bill also mandates that insurance carriers annually notify enrollees about these new coverage requirements and how to access the contraceptives. The Department of Professional and Financial Regulation's Bureau of Insurance is tasked with monitoring implementation, reviewing any related federal guidance, and reporting to the Legislature by November 4, 2026, with recommendations for potential improvements to the law.

Committee Categories

Health and Social Services

Sponsors (10)

Last Action

On motion by Senator ROTUNDO of Androscoggin PLACED ON THE SPECIAL APPROPRIATIONS TABLE pending ENACTMENT in concurrence. (on 05/21/2025)

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