                                 CODE OF VIRGINIA

REIMBURSEMENTS FOR DISPENSING HORMONAL CONTRACEPTIVES (§ 38.2-3407.5:2)

A. As used in this section:
			&#8220;Covered person&#8221; means a policyholder, subscriber, enrollee,
participant, or other individual covered by a health benefit
plan.			&#8220;Health benefit plan&#8221; means any accident and health
insurance policy or certificate, health services plan contract, health
maintenance organization subscriber contract, plan provided by a multiple
employer welfare arrangement (MEWA), or plan provided by another benefit
arrangement. &#8220;Health benefit plan&#8221; does not mean accident only,
credit, or disability insurance; coverage of Medicare services or federal
employee health plans, pursuant to contracts with the United States government;
Medicare supplement or long-term care insurance; Medicaid coverage; dental only
or vision only insurance; specified disease insurance; hospital confinement
indemnity coverage; limited benefit health coverage; short-term limited duration
coverage; coverage issued as a supplement to liability insurance; insurance
arising out of a workers&#8217; compensation or similar law; automobile medical
payment insurance; medical expense and loss of income benefits; or insurance
under which benefits are payable with or without regard to fault and that is
statutorily required to be contained in any liability insurance policy or
equivalent self-insurance.			&#8220;Health carrier&#8221; means an entity
subject to the insurance laws and regulations of the Commonwealth and subject to
the jurisdiction of the Commission that contracts or offers to contract to
provide a health benefit plan.			&#8220;Hormonal contraceptive&#8221; means a
medication taken to prevent pregnancy by means of ingestion of hormones,
including medications containing estrogen or progesterone, that is
self-administered, requires a prescription, and is approved by the U.S. Food and
Drug Administration for such purpose.			&#8220;Provider&#8221; means a facility,
physician or other type of health care practitioner licensed, accredited,
certified or authorized by statute to deliver or furnish health care items or
services.

B. Any health benefit plan that is amended, renewed, or delivered on or after
January 1, 2018, that provides coverage for hormonal contraceptives shall cover
up to a 12-month supply of hormonal contraceptives when dispensed or furnished
at one time for a covered person by a provider or pharmacy or at a location
licensed or otherwise authorized to dispense drugs or supplies.

C. Nothing in this section shall be construed to require a provider to
prescribe, furnish, or dispense 12 months of self-administered hormonal
contraceptives at one time.

D. A health benefit plan that provides coverage for hormonal contraceptives, in
the absence of clinical contraindications, shall not impose utilization controls
or other forms of medical management limiting the supply of hormonal
contraceptives that may be dispensed or furnished by a provider or pharmacy, or
at a location licensed or otherwise authorized to dispense drugs or supplies, to
an amount that is less than a 12-month supply.

E. This section shall not be construed to exclude coverage for hormonal
contraceptives as prescribed by a provider, acting within his scope of practice,
for reasons other than contraceptive purposes, such as decreasing the risk of
ovarian cancer or eliminating symptoms of menopause, or for contraception that
is necessary to preserve the life or health of an enrollee.

F. Nothing in this section shall be construed to require a health carrier to
cover hormonal contraceptives provided by a provider or pharmacy or at a
location licensed or otherwise authorized to dispense drugs or supplies, that
does not participate in the health carrier&#8217;s provider network, except as
may be otherwise authorized or required by state law or by the plan&#8217;s
policies governing out-of-network coverage.

HISTORY: 2017, c. 716.