Pierson Bill Makes Health Plans Cover Menopause Medications

The text as introduced · 399 words

89R14910 SCF-D

By: Pierson
H.B. No. 3814

A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for perimenopause and

menopause medications.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 1369, Insurance Code, is amended by

adding Subchapter O to read as follows:

SUBCHAPTER O. COVERAGE OF PERIMENOPAUSE AND MENOPAUSE MEDICATIONS

Sec. 1369.751. APPLICABILITY OF SUBCHAPTER. (a) This

subchapter applies only to a health benefit plan that provides

benefits for medical, surgical, or prescription drug expenses

incurred as a result of a health condition, accident, or sickness,

including an individual, group, blanket, or franchise insurance

policy or insurance agreement, a group hospital service contract,

or an individual or group evidence of coverage or similar coverage

document that is issued by:

(1) an insurance company;

(2) a group hospital service corporation operating

under Chapter 842;

(3) a health maintenance organization operating under

Chapter 843;

(4) an approved nonprofit health corporation that

holds a certificate of authority under Chapter 844;

(5) a multiple employer welfare arrangement that holds

a certificate of authority under Chapter 846;

(6) a stipulated premium company operating under

Chapter 884;

(7) a fraternal benefit society operating under

Chapter 885;

(8) a Lloyd's plan operating under Chapter 941; or

(9) an exchange operating under Chapter 942.

(b) Notwithstanding any other law, this subchapter applies

to:

(1) a basic coverage plan under Chapter 1551;

(2) a basic plan under Chapter 1575;

(3) a primary care coverage plan under Chapter 1579;

(4) a plan providing basic coverage under Chapter

1601; and

(5) the state Medicaid program, including the Medicaid

managed care program operated under Chapter 540, Government Code.

Sec. 1369.752. COVERAGE REQUIRED FOR PERIMENOPAUSE OR

MENOPAUSE MEDICATIONS. A health benefit plan that provides

prescription drug benefits must provide coverage for a prescription

drug to treat perimenopause or menopause.

SECTION 2. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 3. The changes in law made by this Act apply only to

a health benefit plan delivered, issued for delivery, or renewed on

or after January 1, 2026.

SECTION 4. This Act takes effect September 1, 2025.