Hormones are chemicals produced by endocrine glands in the body. They create chemicals that coordinate different functions in the body by sending specific signals to particular organs. They control numerous bodily processes such as metabolism, regulating blood pressure and blood sugar, growth and development, sexual function, reproduction, the sleep-wake cycle, and mood.
Hormone therapy uses medications to control the levels or effects of hormones in the body for different medical purposes. Hormone therapy can be used for symptoms of menopause, gender affirming treatment, low testosterone in men, infertility, treatments for different types of cancer, growth hormones for children, puberty blockers for early puberty, thyroid disorders, and other conditions.
Health plans issued or renewed on or after January 1, 2026, including health plans issued to public and school employees, that include coverage for prescription hormone therapy must provide reimbursement for a 12-month refill of covered hormone therapy obtained at one time by the enrollee.
There are exceptions to the 12-month refill requirement for prescription hormone therapy if:
If the prescription drug is a controlled substance, then the health plan must provide reimbursement for the maximum refill allowed by state and federal law.
The health plan's dispensing practices must follow clinical guidelines for appropriate prescribing and dispensing to ensure the health of the patient while maximizing access to effective prescription hormone therapy. Health plans may apply drug utilization management strategies to prescription hormone therapy drugs.
The term "prescription hormone therapy" is defined as all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels. The term does not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.
The substitute bill allows health plans to apply drug utilization management strategies to prescription hormone therapy, except as prohibited in the act or state or federal law.
(In support) This bill gives providers and patients the flexibility they need to adjust prescription length based on what they determine is best for the patient's needs. This bill does not expand coverage and does not dictate the type of care that a doctor might recommend, but it simply makes sure that people can get the medications that they rely on for their health and well-being. This bill is particularly important for those who live in rural areas, those without transportation, and those who work multiple jobs or have low incomes. This bill will make it easier for people living in Washington to have consistent access to necessary medications by taking steps to improve access to hormone treatment. This bill comes from community members who are concerned that, despite Washington's legal protections, without access to care, those protections are meaningless. This bill will support people's emotional health by letting them know that this kind of security for their care exists.
(Opposed) None.
Everett Maroon, WA State LGBTQ Commission; and Dr. Deb Nucatola, Planned Parenthood Great Northwest.