{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.5_2.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.5_2.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.5_2.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.5_2.html"}],"law_id":79611,"edition_id":1,"section_id":79611,"structure_id":12994,"section_number":"38.2-3407.5:2","catch_line":"Reimbursements for dispensing hormonal contraceptives","history":"2017, c. 716.","full_text":"A\n\nAs used in this section:\n\t\t\t“Covered person” means a policyholder, subscriber, enrollee, participant, or other individual covered by a health benefit plan.\n\t\t\t“Health benefit plan” 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. “Health benefit plan” 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’ 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.\n\t\t\t“Health carrier” 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.\n\t\t\t“Hormonal contraceptive” 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.\n\t\t\t“Provider” 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\n\nAny 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\n\nNothing 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\n\nA 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\n\nThis 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\n\nNothing 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’s provider network, except as may be otherwise authorized or required by state law or by the plan’s policies governing out-of-network coverage.","order_by":null,"text":{"0":{"id":285245,"text":"As used in this section:\n\t\t\t“Covered person” means a policyholder, subscriber, enrollee, participant, or other individual covered by a health benefit plan.\n\t\t\t“Health benefit plan” 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. “Health benefit plan” 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’ 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.\n\t\t\t“Health carrier” 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.\n\t\t\t“Hormonal contraceptive” 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.\n\t\t\t“Provider” 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.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":285246,"text":"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.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":285247,"text":"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.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":285248,"text":"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.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":285249,"text":"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.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":285250,"text":"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’s provider network, except as may be otherwise authorized or required by state law or by the plan’s policies governing out-of-network coverage.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E"}},"ancestry":[{"id":12994,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214889,"object_type":"structure","relational_id":12994,"identifier":"1","token":"38.2\/34\/1","url":"\/38.2\/34\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 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contraceptives","url":"\/38.2-3407.5_1\/","token":"38.2\/34\/1\/38.2-3407.5_1","metadata":false},"next_section":{"id":83778,"structure_id":12994,"section_number":"38.2-3407.6","catch_line":"Exclusion of podiatrist not permitted under certain circumstances","url":"\/38.2-3407.6\/","token":"38.2\/34\/1\/38.2-3407.6","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3407.5:2\/","history_text":"

This law was first created in 2017. The record of its establishment is cataloged in chapter 716<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":false,"refers_to":false,"permalink":{"id":215099,"object_type":"law","relational_id":79611,"identifier":"38.2-3407.5:2","token":"38.2\/34\/1\/38.2-3407.5_2","url":"\/38.2-3407.5_2\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.5_2\/","token":"38.2\/34\/1\/38.2-3407.5_2","dublin_core":{"Title":"Reimbursements for dispensing hormonal contraceptives","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.5:2","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section:\n\t\t\t“Covered person<\/span>” means a policyholder, subscriber, enrollee, participant, or other individual covered by a health benefit plan<\/span>.\n\t\t\t“Health benefit plan<\/span>” means any accident and health insurance<\/span> policy or certificate, health services plan<\/span> contract<\/span>, health maintenance organization subscriber contract<\/span>, plan provided by a multiple employer welfare arrangement (MEWA), or plan provided by another benefit arrangement. “Health benefit plan<\/span>” does not mean accident only, credit, or disability insurance<\/span>; coverage of Medicare<\/span> services or federal employee health plans, pursuant to contracts<\/span> with the United States<\/span> government; Medicare<\/span> supplement or long-term care insurance<\/span>; Medicaid coverage; dental only or vision only insurance<\/span>; specified disease insurance<\/span>; hospital confinement indemnity coverage; limited benefit health coverage; short-term limited duration coverage; coverage issued as a supplement to liability insurance<\/span>; insurance<\/span> arising out of a workers’ compensation or similar law<\/span>; automobile medical payment insurance<\/span>; medical expense and loss of income benefits; or insurance<\/span> under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance<\/span> policy or equivalent self-insurance<\/span>.\n\t\t\t“Health carrier<\/span>” means an entity subject to the insurance<\/span> laws<\/span> and regulations of the Commonwealth and subject to the jurisdiction<\/span> of the Commission<\/span> that contracts<\/span> or offers to contract<\/span> to provide a health benefit plan<\/span>.\n\t\t\t“Hormonal contraceptive<\/span>” 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.\n\t\t\t“Provider<\/span>” means a facility, physician or other type of health care practitioner licensed, accredited, certified or authorized by statute<\/span> to deliver or furnish health care items or services. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

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

C.<\/span> Nothing in this section shall be construed to require a provider<\/span> to prescribe, furnish, or dispense 12 months of self-administered hormonal contraceptives<\/span> at one time. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> A health benefit plan<\/span> that provides coverage for hormonal contraceptives<\/span>, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of hormonal contraceptives<\/span> that may be dispensed or furnished by a provider<\/span> 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. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> This section shall not be construed to exclude coverage for hormonal contraceptives<\/span> as prescribed by a provider<\/span>, 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. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> Nothing in this section shall be construed to require a health carrier<\/span> to cover hormonal contraceptives<\/span> provided by a provider<\/span> or pharmacy or at a location licensed or otherwise authorized to dispense drugs or supplies, that does not participate in the health carrier<\/span>’s provider<\/span> network, except as may be otherwise authorized or required by state<\/span> law<\/span> or by the plan’s policies governing out-of-network coverage. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nREIMBURSEMENTS FOR DISPENSING HORMONAL CONTRACEPTIVES (\u00a7 38.2-3407.5:2)\n\nA. As used in this section:\n\t\t\t“Covered person” means a policyholder, subscriber, enrollee,\nparticipant, or other individual covered by a health benefit plan.\n\t\t\t“Health benefit plan” means any accident and health insurance\npolicy or certificate, health services plan contract, health maintenance\norganization subscriber contract, plan provided by a multiple employer welfare\narrangement (MEWA), or plan provided by another benefit arrangement.\n“Health benefit plan” does not mean accident only, credit, or\ndisability insurance; coverage of Medicare services or federal employee health\nplans, pursuant to contracts with the United States government; Medicare\nsupplement or long-term care insurance; Medicaid coverage; dental only or vision\nonly insurance; specified disease insurance; hospital confinement indemnity\ncoverage; limited benefit health coverage; short-term limited duration coverage;\ncoverage issued as a supplement to liability insurance; insurance arising out of\na workers’ compensation or similar law; automobile medical payment\ninsurance; medical expense and loss of income benefits; or insurance under which\nbenefits are payable with or without regard to fault and that is statutorily\nrequired to be contained in any liability insurance policy or equivalent\nself-insurance.\n\t\t\t“Health carrier” means an entity subject to the insurance laws\nand regulations of the Commonwealth and subject to the jurisdiction of the\nCommission that contracts or offers to contract to provide a health benefit\nplan.\n\t\t\t“Hormonal contraceptive” means a medication taken to prevent\npregnancy by means of ingestion of hormones, including medications containing\nestrogen or progesterone, that is self-administered, requires a prescription,\nand is approved by the U.S. Food and Drug Administration for such purpose.\n\t\t\t“Provider” means a facility, physician or other type of health\ncare practitioner licensed, accredited, certified or authorized by statute to\ndeliver or furnish health care items or services.\n\nB. Any health benefit plan that is amended, renewed, or delivered on or after\nJanuary 1, 2018, that provides coverage for hormonal contraceptives shall cover\nup to a 12-month supply of hormonal contraceptives when dispensed or furnished\nat one time for a covered person by a provider or pharmacy or at a location\nlicensed or otherwise authorized to dispense drugs or supplies.\n\nC. Nothing in this section shall be construed to require a provider to\nprescribe, furnish, or dispense 12 months of self-administered hormonal\ncontraceptives at one time.\n\nD. A health benefit plan that provides coverage for hormonal contraceptives, in\nthe absence of clinical contraindications, shall not impose utilization controls\nor other forms of medical management limiting the supply of hormonal\ncontraceptives that may be dispensed or furnished by a provider or pharmacy, or\nat a location licensed or otherwise authorized to dispense drugs or supplies, to\nan amount that is less than a 12-month supply.\n\nE. This section shall not be construed to exclude coverage for hormonal\ncontraceptives as prescribed by a provider, acting within his scope of practice,\nfor reasons other than contraceptive purposes, such as decreasing the risk of\novarian cancer or eliminating symptoms of menopause, or for contraception that\nis necessary to preserve the life or health of an enrollee.\n\nF. Nothing in this section shall be construed to require a health carrier to\ncover hormonal contraceptives provided by a provider or pharmacy or at a\nlocation licensed or otherwise authorized to dispense drugs or supplies, that\ndoes not participate in the health carrier’s provider network, except as\nmay be otherwise authorized or required by state law or by the plan’s\npolicies governing out-of-network coverage.\n\nHISTORY: 2017, c. 716.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}