Senate committee reports bill to require insurer coverage for menopause care, removes prior-authorization language

During a Senate committee meeting in Richmond, members moved to report a bill from the Commerce and Labor Committee that would require health insurers to cover medically necessary treatment for menopause and perimenopause and would prohibit prior authorization and step-therapy protocols for hormone replacement therapy, with the rule taking effect Jan. 1, 2027.

Unidentified Speaker 3, who summarized the measure for the committee, said: "Basically what it does is it requires all health insurers, to basically provide coverage for medical necessary treatment and care for menopause and perimenopause." The speaker added the bill "prohibits any insurer from requiring a prior authorization or otherwise a step therapy policy or protocol for the administration of any prescription ... for hormone replacement therapy." The presenter also said, "From a fiscal impact standpoint, it's my understanding it will not impact the state health plans, offered by the Department of Human Resource Management," while noting state and federal benchmarks and Medicaid impact would need confirmation from the State Corporation Commission and DMAS.

Members debated procedure. Unidentified Speaker 2 asked whether the measure should be routed through the Health Insurance Reform Commission for technical review, referencing past Commerce and Labor discussion and a staff member (Doug Gray) who had suggested many insurers already provide such coverage. "Most people are already covering this. Most companies are already covering this," Unidentified Speaker 2 said. Unidentified Speaker 4 said committee staff did not have answers to questions about the prior-authorization and step-therapy restrictions and that those uncertainties were normally a reason to send the bill to the commission.

Rather than hold the bill for further review, members agreed to remove the unclear prior-authorization/step-therapy limits so the bill could move forward. Unidentified Speaker 4 moved to report the bill with those provisions removed; the motion was seconded by Unidentified Speaker 2. The transcript records committee agreement and the chair stating the bill was "reported"; no roll-call vote or numeric tally appears in the record.

The measure remains reported from the committee with the prior-authorization and step-therapy language slated for removal; the transcript does not record final vote tallies or subsequent referral steps.