                                 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.