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 unless:

• the enrollee requests a smaller supply;
• the prescribing provider instructs that the enrollee must have a smaller supply; or
• the prescription hormone therapy is a controlled substance.

The 12-month refill requirement only applies to prescription hormone therapy that can be safely stored at room temperature. 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. 

This act does not prohibit a health plan from limiting refills that may be obtained in the last quarter of a plan year when a 12-month supply has already been dispensed during the plan year or a prescribing provider temporarily limiting refills to a 90-day supply due to an acute dispensing shortage during the plan year.

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. 

PRO: This will allow for better continuity of care. This bill respects patient privacy and makes lives easier when getting to a pharmacy monthly is not convenient. This bill will save the lives of trans people by allowing continued access to drugs. The bill can help limit out of pocket expenses.