Signed by Governor Michelle Lujan Grisham

Vote Smart's Synopsis:

Vote to pass a bill that requires insurance companies to provide coverage for contraceptives to both men and women.

Highlights:

• Requires that group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs to provide, at minimum, the following (Sec. 1):

• At least one product or form of contraception in each contraceptive method categories that are identified by the federal Food and Drug Administration;

• A sufficient number of contraceptive pills to reflect the variety of contraceptives approved by the Food and Drug Administration; and

• Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, counseling, device insertion and removal, follow-up care and side-effects management.

• Prohibits the coverage from being subject to the following, including (Sec. 1):

• Enrollee cost sharing;

• Utilization review;

• Prior authorization or step therapy requirements; or

• Any other restrictions or delays on the coverage.

• Authorizes a group health plan to discourage brand-name pharmacy drugs or items by applying cost sharing to brand-name drugs when at least one generic or therapeutic equivalent is covered within the same method of contraception without patient cost sharing (Sec. 1).

• Requires the group health plan to cover the brand-name pharmacy drug or item without cost sharing, when an enrollee’s health care provider determines that a particular drug or item is medically necessary (Sec. 1).

• Authorizes medical necessity to include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the druge (Sec. 1).

• Prohibits a group health plan from requiring a prescription for any drug, item or service that is available without a prescription (Sec. 1).

• Specifies that nothing in this bill is to be construed to require a health care provider to prescribe six months of contraceptives at one time; or permit a group health plan to limit coverage or impose cost sharing fo an alternate method of contraception if an enrollee changes contraceptive methods before exhausting a previously dispensed supply (Sec. 1).

• Requires the department to ensure that a recipient is permitted to fill or refill a prescription for a one-year supply of a covered, self-administered contraceptive at one time (Sec. 2).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that requires insurance companies to provide coverage for contraceptives to both men and women.

Highlights:

• Requires that group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for prescription drugs to provide, at minimum, the following (Sec. 1):

• At least one product or form of contraception in each contraceptive method categories that are identified by the federal Food and Drug Administration;

• A sufficient number of contraceptive pills to reflect the variety of contraceptives approved by the Food and Drug Administration; and

• Clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, counseling, device insertion and removal, follow-up care and side-effects management.

• Prohibits the coverage from being subject to the following, including (Sec. 1):

• Enrollee cost sharing;

• Utilization review;

• Prior authorization or step therapy requirements; or

• Any other restrictions or delays on the coverage.

• Authorizes a group health plan to discourage brand-name pharmacy drugs or items by applying cost sharing to brand-name drugs when at least one generic or therapeutic equivalent is covered within the same method of contraception without patient cost sharing (Sec. 1).

• Requires the group health plan to cover the brand-name pharmacy drug or item without cost sharing, when an enrollee’s health care provider determines that a particular drug or item is medically necessary (Sec. 1).

• Authorizes medical necessity to include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the druge (Sec. 1).

• Prohibits a group health plan from requiring a prescription for any drug, item or service that is available without a prescription (Sec. 1).

• Specifies that nothing in this bill is to be construed to require a health care provider to prescribe six months of contraceptives at one time; or permit a group health plan to limit coverage or impose cost sharing fo an alternate method of contraception if an enrollee changes contraceptive methods before exhausting a previously dispensed supply (Sec. 1).

• Requires the department to ensure that a recipient is permitted to fill or refill a prescription for a one-year supply of a covered, self-administered contraceptive at one time (Sec. 2).

Full Bill Text