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.
Summary
HB767 would require both state-regulated health benefit plans and Ohio Medicaid to cover the diagnosis and treatment of menopause, perimenopause, and related symptoms. Covered services would include clinical evaluations, diagnostic testing, provider visits, FDA-approved hormone therapy in multiple forms, and FDA-approved nonhormonal treatments. The bill also allows coverage of non-FDA-approved formulations when approved options are contraindicated or ineffective, as determined by a prescriber, and it bars plans from requiring patients to try approved formulations first in those circumstances.
The bill further prohibits health plans from treating menopause-related care as elective or cosmetic and limits cost-sharing and utilization management so they cannot be more restrictive than those applied to substantially all other medical benefits under the plan. It directs the Superintendent of Insurance to adopt rules to implement the insurance provisions. For Medicaid, the bill imposes similar coverage requirements and a parallel prohibition on classifying menopause-related care as elective or cosmetic. The act is named the Ohio Menopause, Perimenopause, and Hormone Therapy Coverage Act.
Impact
HB767 would add new sections 3902.65 and 5164.081 to the Revised Code, creating explicit coverage mandates for menopause-related care in private insurance and Medicaid. It would affect insurers offering health benefit plans in Ohio, the Ohio Department of Insurance, and the Medicaid program by requiring coverage of specified diagnostic and treatment services and by limiting prior authorization, formulary management, and cost-sharing practices for those services. The bill would also establish a state policy that menopause and perimenopause treatment are medically necessary rather than elective or cosmetic.
Sentiment
The available context shows the bill was introduced and referred to the House Insurance Committee, but there are no recorded committee transcripts or votes in the provided materials. Based on the bill text, the measure appears to have been framed positively as a women’s health and access-to-care bill, with findings emphasizing updated federal labeling and clinical standards for menopausal hormone therapy. No opposing viewpoints are documented in the provided record.
Contention
The main policy issues likely to generate debate are the scope of mandated coverage, especially the requirement to cover non-FDA-approved formulations when FDA-approved options are contraindicated or ineffective, and the limits placed on insurer utilization management and cost-sharing. Insurers may object to the mandate as increasing costs or reducing plan flexibility, while supporters are likely to argue that menopause care has been undercovered and should not be treated as elective. Another possible point of contention is the inclusion of Medicaid, which could raise fiscal concerns for the state.