Some insurance plans cover part or all of the cost of BHRT, while others do not resulting in patients having to forego treatment or obtain with tremendous financial burdens.
A Bill to Mandate Coverage of Bioidentical Hormone Replacement Therapy by Insurance Providers seeks to ensure that patients who prefer bioidentical hormones have equal access to treatment under their health insurance plans without facing financial or administrative barriers.
Section 1. Short Title
This Act may be cited as the “Bioidentical Hormone Replacement Therapy Coverage Act of 2024.”
Section 2. Findings
Congress finds the following:
1. Bioidentical hormone replacement therapy (BHRT) offers a natural alternative to synthetic hormone replacement therapy (HRT) and is used to treat hormone imbalances related to menopause, andropause, and other conditions.
2. Many patients report improved quality of life with BHRT compared to traditional HRT, yet insurance coverage for BHRT is inconsistent, often leaving patients with significant out-of-pocket costs.
3. Hormone replacement therapy (HRT) is routinely covered by insurance, but bioidentical versions of the same hormones are often excluded from coverage, despite being recognized as effective treatments.
4. Equal access to BHRT through insurance coverage would promote patient choice, allow for individualized treatment plans, and improve health outcomes for those experiencing hormonal imbalances.
Section 3. Definitions
For purposes of this Act:
1. The term “bioidentical hormone replacement therapy (BHRT)” refers to the use of hormones that are chemically identical to those the human body produces, including but not limited to estradiol, progesterone, testosterone, and other hormones used to treat hormonal deficiencies or imbalances.
2. The term “hormone replacement therapy (HRT)” refers to the treatment of hormonal deficiencies or imbalances with synthetic or non-bioidentical hormones.
3. The term “health insurance issuer” refers to any insurance company, health maintenance organization, employer-sponsored health plan, or any other entity that provides or arranges for the provision of health insurance coverage.
4. The term “covered services” refers to any treatments, medications, or therapies that are included as part of a health insurance plan’s benefits package.
Section 4. Mandate for Equal Coverage of Bioidentical Hormone Replacement Therapy
(a) Coverage Requirement:
All health insurance issuers providing coverage for hormone replacement therapy (HRT) shall be required to cover bioidentical hormone replacement therapy (BHRT) to the same extent and in the same manner as traditional hormone replacement therapy.
(b) Parity in Coverage:
Insurance coverage for BHRT must include:
1. Prescription Coverage: All forms of bioidentical hormone therapy, whether compounded or FDA-approved, shall be covered if prescribed by a licensed healthcare provider.
2. Access to Medications: BHRT medications must be covered on insurance formularies in the same way as synthetic HRT medications, including oral, transdermal, topical, injectable, or implantable forms.
3. Copays, Deductibles, and Coinsurance: Patient costs for BHRT, including copayments, deductibles, and coinsurance, must be identical to those for synthetic HRT under the same health plan.
4. Medical Necessity: BHRT prescribed by a licensed healthcare provider for the treatment of menopausal symptoms, andropause, or any other hormone imbalance or deficiency shall be deemed medically necessary and covered as such.
(c) No Discrimination in Coverage:
Health insurance issuers may not impose any additional coverage limitations, prior authorization requirements, or exclusions specific to BHRT that are not applied to HRT.
Section 5. Compounded Bioidentical Hormones
(a) Coverage of Compounded BHRT:
If a licensed healthcare provider prescribes compounded bioidentical hormones, health insurance issuers must cover the cost of these medications, provided that the compounded medications are legally and safely compounded by a licensed pharmacy or compounding facility.
(b) Safety Standards:
Compounded bioidentical hormones covered under this Act must comply with federal safety and regulatory standards, including oversight by the Food and Drug Administration (FDA) or applicable state pharmacy boards.
Section 6. Prohibition of Discriminatory Practices
Health insurance issuers may not:
1. Deny coverage or impose additional financial burdens on patients seeking BHRT when such treatments are prescribed to address hormone deficiencies or imbalances.
2. Refuse coverage for BHRT on the basis that it is “alternative” or “non-standard” when such treatments are prescribed in accordance with accepted medical standards.
Section 7. Implementation and Oversight
(a) Enforcement:
The Department of Health and Human Services (HHS) and state insurance regulatory authorities shall be responsible for enforcing compliance with this Act.
(b) Implementation Timeline:
Health insurance issuers shall be required to comply with the provisions of this Act within 180 days of its enactment.
(c) Public Reporting:
The Department of Health and Human Services shall provide annual reports to Congress on the compliance of health insurance issuers with this Act, including data on any denials of BHRT coverage and enforcement actions taken.
Section 8. Effective Date
This Act shall take effect upon its enactment.
Summary of the Bill:
• Mandatory Coverage: The bill requires insurance companies to cover bioidentical hormone replacement therapy (BHRT) in the same manner as they cover traditional hormone replacement therapy (HRT).
• Cost Parity: Insurance plans must ensure that patient costs (copays, deductibles, etc.) for BHRT are the same as for synthetic HRT.
• Compounded Medications: Compounded bioidentical hormones, if prescribed, must be covered as long as they meet safety standards.
• Prohibition on Discrimination: Insurance companies may not impose additional restrictions or exclusions on BHRT that are not applied to HRT.
• Implementation and Enforcement: The Department of Health and Human Services will oversee the enforcement of the law.