As Introduced

136th General Assembly

Regular Session H. B. No. 767

2025-2026

To enact sections 3902.65 and 5164.081 of the Revised Code to require insurance and Medicaid coverage of the diagnosis and treatment of menopause, perimenopause, and menopausal and perimenopausal symptoms and to name this act the Ohio Menopause, Perimenopause, and Hormone Therapy Coverage Act.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3902.65 and 5164.081 of the Revised Code be enacted to read as follows:

Sec. 3902.65. (A) As used in this section:

(1) "Prescriber" means the following:

(a) A physician authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery;

(b) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner who holds a current, valid license issued under Chapter 4723. of the Revised Code to practice nursing as an advanced practice registered nurse;

(c) A physician assistant who holds a license to practice as a physician assistant issued under Chapter 4730. of the Revised Code, holds a valid prescriber number issued by the state medical board, and has been granted physician-delegated prescriptive authority.

(2) "Menopausal and perimenopausal symptoms" include vasomotor symptoms, sleep disruption, mood changes, cognitive changes, fatigue, and related symptoms clinically recognized as related to menopause and perimenopause.

(B) On and after the effective date of this section and notwithstanding section 3901.71 of the Revised Code, a health benefit plan shall provide coverage for the following as they relate to the diagnosis and treatment of menopause, perimenopause, and menopausal and perimenopausal symptoms:

(1) Clinical laboratory services, clinical evaluation services, diagnostic services, and provider visits;

(2) Menopausal and perimenopausal hormone therapy administered orally, transdermally, vaginally, or by injection and approved by the United States food and drug administration;

(3) Nonhormonal treatments for menopausal and perimenopausal symptoms approved by the United States food and drug administration;

(4) Menopausal and perimenopausal hormone therapy and nonhormonal treatments administered in formulations not approved by the United States food and drug administration when menopausal and perimenopausal hormone therapy and nonhormonal treatments approved by the United States food and drug administration are contraindicated or ineffective, as determined by a prescriber, without requiring a patient to first attempt any therapy or treatment administered in a formulation approved by the United States food and drug administration.

(C) A health benefit plan shall not impose a cost-sharing requirement for coverage required under division (B) of this section that exceeds the cost-sharing requirements that apply to substantially all medical benefits under the health benefit plan. This division shall not be interpreted to prohibit a health benefit plan from applying a cost-sharing requirement that is consistent with cost-sharing requirements that apply to substantially all medical benefits under the health benefit plan.

(D) A health benefit plan shall not apply utilization management requirements, including prior authorization or formulary management, for coverage required under division (B) of this section that are more restrictive than utilization management requirements that apply to substantially all medical benefits under the health benefit plan. This division shall not be interpreted to prohibit a health benefit plan from applying utilization management requirements that are consistent with utilization management requirements that apply to substantially all medical benefits under the health benefit plan.

(E) A health benefit plan shall not deem the diagnosis or treatment of menopause, perimenopause, and menopausal and perimenopausal symptoms to be elective or cosmetic in nature.

(F) The superintendent of insurance shall adopt rules in accordance with Chapter 119. of the Revised Code as necessary to carry out the requirements of this section.

(G) The general assembly finds that recent product labeling updates by the United States department of health and human services and the United States food and drug administration have clarified the safety profile of menopausal hormone therapy. It is the intent of this act to align state-regulated health coverage with current federal guidance and clinical standards for treatment with menopausal hormone therapy.

Sec. 5164.081. (A) As used in this section, "prescriber" and "menopausal and perimenopausal symptoms" have the same meanings as in section 3902.65 of the Revised Code.

(B) The medicaid program shall cover the following as they relate to the diagnosis and treatment of menopause, perimenopause, and menopausal and perimenopausal symptoms:

(1) Clinical laboratory services, clinical evaluation services, diagnostic services, and provider visits;

(2) Menopausal and perimenopausal hormone therapy administered orally, transdermally, vaginally, or by injection and approved by the United States food and drug administration;

(3) Nonhormonal treatments for menopausal and perimenopausal symptoms approved by the United States food and drug administration;

(4) Menopausal and perimenopausal hormone therapy and nonhormonal treatments administered in formulations not approved by the United States food and drug administration when menopausal and perimenopausal hormone therapy and nonhormonal treatments approved by the United States food and drug administration are contraindicated or ineffective, as determined by a prescriber, without requiring a patient to first attempt any therapy or treatment formulation approved by the United States food and drug administration.

(C) The medicaid program shall not deem the diagnosis or treatment of menopause, perimenopause, and menopausal and perimenopausal symptoms to be elective or cosmetic in nature.

(D) The general assembly finds that recent product labeling updates by the United States department of health and human services and the United States food and drug administration have clarified the safety profile of menopausal hormone therapy. It is the intent of this act to align state Medicaid program coverage with current federal guidance and clinical standards for treatment with menopausal hormone therapy.

Section 2. This act shall be known as the Ohio Menopause, Perimenopause, and Hormone Therapy Coverage Act.