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DMHC outlines menopause coverage mandate and PBM oversight; lawmakers, providers and industry offer feedback
Summary
The Department of Managed Health Care presented several budget change proposals and trailer‑bill items including a menopause coverage mandate with outreach funding and expanded PBM licensing and enforcement under AB116/SB41; medical groups and drugmakers offered implementation concerns and wording suggestions.
The Department of Managed Health Care described multiple proposals intended to expand consumer protections and oversight.
DMHC staff presented a menopause proposal that would require plans to cover FDA‑approved menopause treatments when medically necessary, provide annual menopause assessments for enrollees age 40 and older, biannual notices to enrollees and providers, and support provider education; the proposal includes $3 million for a state outreach campaign and staffing for…
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