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2018 SESSION
18104374DBe it enacted by the General Assembly of Virginia:
1. That § 38.2-3407.05:1 of the Code of Virginia is amended and reenacted as follows:
§ 38.2-3407.5:1. Coverage for prescription contraceptives.
A. As used in this section:
"Contraceptive device" means any contraceptive device or non-drug product that has been approved by the FDA.
"Contraceptive drug" includes any drug approved by the FDA to prevent an unwanted pregnancy.
"FDA" means the U.S. Food and Drug Administration.
"Medical need" includes considerations such as severity of side effects, difference in permanence and reversibility of a contraceptive drug or device, or an ability to adhere to the appropriate use of the item, as determined by the attending health care provider.
B. Each
(i) insurer proposing to issue individual or group accident and sickness
insurance policies providing hospital, medical and surgical or major medical
coverage on an expense incurred basis; (ii) corporation providing individual or
group accident and sickness subscription contracts; and (iii) health
maintenance organization providing a health care plan for health care services,
whose policy, contract or plan, including any certificate or evidence of
coverage issued in connection with such policy, contract or plan, includes
coverage for prescription drugs on an outpatient basis, shall offer and make available provide coverage thereunder
for any prescribed contraceptive
drug or contraceptive device approved by the United States Food and Drug
Administration for use as a contraceptive.
B. C. No
insurer, corporation or health maintenance organization shall impose upon any
person receiving prescription
contraceptive benefits pursuant to this section any (i) copayment, coinsurance
payment or fee that is not equally imposed upon all individuals
in the same benefit category, class, coinsurance level or copayment level
receiving benefits for prescription drugs, or (ii)
reduction in allowable reimbursement for prescription drug benefits.
C. D. If the FDA has
approved one or more therapeutic equivalent versions of a contraceptive drug or
contraceptive device, an insurer may
provide coverage for more than one contraceptive drug or contraceptive
device and may impose cost-sharing requirements as
long as at least one is available without cost sharing.
E. If a covered individual's health care provider recommends a particular contraceptive drug or contraceptive device approved by the FDA for the individual based on a determination of medical need, the insurer shall defer to the provider's determination and judgment and shall provide coverage without cost sharing for the prescribed contraceptive drug or contraceptive device.
F. An entity covered by this section shall not impose any burdensome restrictions or delays on the coverage required in this section and shall provide clear information, in writing, about the contraceptive coverage included and excluded in its offered plans, available on its website and by mail at the request of a present or potential covered individual.
G. The
provisions of subsection A this section shall not be
construed to:
1. Require coverage for prescription coverage benefits in any contract, policy or plan that does not otherwise provide coverage for prescription drugs; or
2. Preclude the use of closed
formularies, provided, however, that such formularies shall include oral,
implant and injectable contraceptive drugs, intrauterine devices and
prescription barrier methods; or
3.
Require coverage for experimental contraceptive drugs not approved by the United States Food and Drug Administration FDA.
D. H. The
provisions of this section shall not apply to short-term travel, accident-only,
limited or specified disease policies, or contracts designed for issuance to
persons eligible for coverage under Title XVIII of the Social Security Act,
known as Medicare, or any other similar coverage under state or federal
governmental plans, or to short-term nonrenewable policies of not more than six
months' duration.
E. The provisions of this
section shall be applicable to contracts, policies or plans delivered, issued
for delivery or renewed in this Commonwealth on and after July 1, 1997.
2. That the provisions of § 38.2-3407.5:1 of the Code of Virginia, as it was in effect prior to the effective date of this act, shall be applicable to contracts, policies, or plans delivered, issued for delivery, or renewed on and after July 1, 1997, but before January 1, 2019, and the provisions of § 38.2-3407.5:1 of the Code of Virginia, as amended by this act, shall be applicable to contracts, policies, or plans delivered, issued for delivery, or renewed on and after January 1, 2019.