HB 169

For a health benefit plan that provides prescription contraceptives coverage, present law requires such a plan that amends, renews, or delivers a policy of coverage on or after July 1, 2024, to provide coverage for a 12-month refill of contraceptives obt ained at one time by an insured person, unless the insured requests a smaller supply or the prescribing healthcare provider instructs that the insured must receive a smaller supply. A health benefit plan that provides coverage must allow the insured to r ec eive the contraceptives on-site at the provider's office, if available, and prescribing, dispensing, and administration practices must follow all clinical guidelines to ensure the health of the patient while maximizing access to effective contraceptives. Present law prohibits a health benefit plan that provides coverage for hormonal contraceptives, in the absence of clinical contraindications, from imposing utilization controls or other forms of medical management limiting the supply of contraceptives th at may be dispensed or furnished by a provider or pharmacy, or at a location licensed or otherwise authorized to dispense drugs or supplies, to an amount that is less than a 12-month supply. However, present law does not require a health benefit plan to cover contraceptives provided by a provider, pharmacy, or at a location authorized to dispense drugs or supplies, that does not participate in the health benefit plan's provider or pharmacy n etwork, as applicable, except as may be otherwise authorized or required by federal or state law or by the plan's policies governing out-of-network coverage. HEALTH BENEFIT PLANS Present law defines "health benefit plan, as used above, as a policy or contract for health insurance coverage provided under either the TennCare program or the CoverKids Act. Beginning January 1, 2026, this bill revises this definition to add that a h ealth benefit plan also means a hospital, surgical, or medical expense policy; health, hospital, or medical service corporation contract; a policy or agreement entered into by a health insurer, or a health maintenance organization contract offered by an e mp loyer; other plan administered by the state; or a certificate issued under those policies, contracts, or plans. However, this bill clarifies that a health benefit plan does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, specified disease, vision care, other li mited benefit health insurance, coverage issued as a supplement to liability insurance, workers' compensation insurance, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that is statut or ily required to be contained in a liability insurance policy or equivalent self-insurance. CONTRACEPTIVES Present law defines a ""contraceptive"" as a device, medication, biological product, or procedure that is intended for use in the prevention of pregnancy, whether specifically intended to prevent pregnancy or for other health needs, and that is legally mar keted under the federal Food, Drug, and Cosmetic Act. This bill removes that the contraceptive must be one that is legally marketed under the federal Food, Drug, and Cosmetic Act. ON FEBRUARY 9, 2026, THE HOUSE ADOPTED AMENDMENT #2 AND PASSED HOUSE BILL 169, AS AMENDED. AMENDMENT #2 makes technical clarifications and the following substantive changes and additions to this bill and present law: (1) Restores present law that specifies this bill will apply only to contraceptives that are legally marketed under the federal Food, Drug, and Cosmetic Act; and (2) Revises the requirements for refills of contraceptives. Present law requires a health benefit plan that amends, renews, or delivers a policy of coverage on or after July 1, 2024, and that provides coverage for prescription contraceptives, to provid e coverage for a 12-month refill of contraceptives obtained at one time by an insured person, unless the insured requests a smaller supply or the prescribing healthcare provider instructs that the insured must receive a smaller supply. This amendment ins te ad requires a health benefit plan that amends, renews, or delivers a policy of coverage on or after July 1, 2027, and that provides coverage for prescription contraceptives, to provide coverage that ensures an insured person is able to refill a 12-month p rescription of contraceptives obtained at one time, upon the request of the insured and unless the prescribing healthcare provider instructs that the insured must receive a smaller supply; and (3) Changes this bill's effective date to July 1, 2027. ON FEBRUARY 19, 2026, THE SENATE SUBSTITUTED HOUSE BILL 169 FOR SENATE BILL 589, ADOPTED AMENDMENT #1, AND PASSED HOUSE BILL 169, AS AMENDED. AMENDMENT #1 removes the provision that requires a health benefit plan that provides prescription contraceptives coverage to allow the insured to receive the contraceptives on-site at the provider's office, if available, and prescribing, dispensing, and administration practices must follow all clinical guidelines to ensure the health of the patient while maximizing access to effective contraceptives."