HB 1435

HOUSE BILL 1435
     J5  6lr3342
     By: Delegates Spiegel, Bouchat, Crutchfield, Foley, Hornberger, Kaiser, Kaufman,
  Miller, Rose, Tomlinson, and Woorman
     Introduced and read first time: February 13, 2026
     Assigned to: Health
  A BILL ENTITLED
1 AN ACT concerning
2Health Insurance – Required Coverage – Hormone–Related Care
3 FOR the purpose of requiring certain insurers, nonprofit health service plans, and health
4      maintenance organizations to provide certain coverage for hormone–related care,
5      including hormone therapy treatment for perimenopausal and menopausal
6      symptoms; establishing certain requirements and prohibitions related to coverage
7      for hormone–related care; and generally relating to health insurance coverage for
8      hormone–related care.
9 BY adding to
10      Article – Insurance
11      Section 15–864
12      Annotated Code of Maryland
13      (2017 Replacement Volume and 2025 Supplement)
14Preamble
15      WHEREAS, Perimenopause and menopause are common, medically recognized
16 hormonal transitions experienced by a substantial portion of Maryland’s adult population;
17 and
18      WHEREAS, Individuals experiencing perimenopause or menopause frequently seek
19 hormone–related care to manage symptoms that, when untreated, can lead to avoidable
20 emergency visits, repeated diagnostic testing, and long–term health complications; and
21WHEREAS, Insurance coverage for clinically appropriate perimenopausal and
22 menopausal hormone therapy is inconsistent across carriers, resulting in delays, denials,
23 and unnecessary administrative barriers; and
     EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
  [Brackets] indicate matter deleted from existing law.
  *hb1435*
2HOUSE BILL 1435
1WHEREAS, Ensuring timely access to medically necessary hormone–related care for
2 perimenopausal and menopausal individuals promotes health stability, reduces long–term
3 system costs, and supports the well–being of Maryland residents; and
4WHEREAS, Establishing uniform statewide standards for hormone–related care is
5 necessary to reduce disparities in coverage, improve health outcomes, and ensure that
6 Marylanders experiencing perimenopause or menopause receive consistent,
7 evidence–based treatment; now, therefore,
8SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
9 That the Laws of Maryland read as follows:
10Article – Insurance
11 15–864.
12(A)    (1)   IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS
13 INDICATED.
14(2)
  “HORMONE–RELATED CARE” MEANS MEDICALLY NECESSARY
15 TREATMENT INVOLVING THE PRESCRIPTION, ADMINISTRATION, MONITORING, OR
16 ADJUSTMENT OF HORMONE THERAPIES FOR ENDOCRINE, REPRODUCTIVE,
17 METABOLIC, PERIMENOPAUSAL, MENOPAUSAL, OR OTHER CONDITIONS.
18(3)   “MEDICALLY NECESSARY” MEANS CARE THAT IS:
19(I)        CONSISTENT WITH GENERALLY ACCEPTED STANDARDS OF
20 MEDICAL PRACTICE;
21(II)   CLINICALLY APPROPRIATE FOR THE PATIENT’S CONDITION;
22 AND
23(III) NOT PRIMARILY FOR THE CONVENIENCE OF THE PATIENT
24 OR PROVIDER.
25(B)    THIS SECTION APPLIES TO:
26(1)
  INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT
27 PROVIDE HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS
28 ON AN EXPENSE–INCURRED BASIS UNDER HEALTH INSURANCE POLICIES OR
29 CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE; AND
  HOUSE BILL 1435  3
1(2)HEALTH    MAINTENANCE    ORGANIZATIONS    THAT  PROVIDE
2 HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS UNDER
3 CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE.
4      (C)AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE COVERAGE FOR
5 HORMONE–RELATED CARE, INCLUDING:
6(1)   HORMONE REPLACEMENT THERAPY;
7(2)   HORMONE SUPPRESSION OR MODULATION THERAPY;
8(3)   HORMONE–MODULATING MEDICATIONS;
9(4)
  LABORATORY    TESTING, DIAGNOSTIC  EVALUATIONS,  AND
10 ONGOING MONITORING RELATED TO HORMONE THERAPY; AND
11(5) CLINICAL VISITS FOR THE INITIATION AND CONTINUATION OF
12 HORMONE THERAPY OR OTHER HORMONE–RELATED CARE.
13      (D)    COVERAGE UNDER THIS SECTION MAY NOT BE DENIED BASED ON:
14(1) THE SPECIFIC DIAGNOSIS FOR WHICH THE HORMONE–RELATED
15 CARE IS     PRESCRIBED, INCLUDING MENOPAUSAL AND PERIMENOPAUSAL
16 SYMPTOMS;
17(2)   THE PATIENT’S AGE; OR
18(3)   PRIOR USE OR NONUSE OF HORMONE–RELATED CARE.
19      (E)    AN ENTITY SUBJECT TO THIS SECTION MAY NOT:
20(1)IMPOSE EXCLUSIONS OR LIMITATIONS ON HORMONE–RELATED
21 CARE THAT ARE MORE RESTRICTIVE THAN THOSE APPLIED TO COMPARABLE
22 PRESCRIPTION DRUGS OR MEDICAL SERVICES;
23(2)REQUIRE PRIOR AUTHORIZATION, STEP THERAPY, OR REPEATED
24 MEDICAL NECESSITY REVIEWS THAT ARE MORE BURDENSOME THAN THOSE
25 APPLIED TO COMPARABLE TREATMENTS;
26(3) DENY COVERAGE SOLELY BECAUSE THE HORMONE–RELATED
27 CARE IS NEEDED AS AN ONGOING, LONG–TERM TREATMENT; OR
4HOUSE BILL 1435
1(4)
  APPLY HIGHER COST–SHARING, COPAYMENTS, OR DEDUCTIBLES
2 FOR HORMONE–RELATED CARE THAN COMPARABLE TREATMENTS.
3      (F)   (1)   ADETERMINATION     OF  MEDICAL    NECESSITY     FOR
4 HORMONE–RELATED CARE SHALL BE BASED ON:
5(I)    EVIDENCE–BASED CLINICAL GUIDELINES;
6(II)   THE   PROFESSIONAL   JUDGMENT      OF   THE   TREATING
7 PROVIDER; AND
8(III) THE INDIVIDUAL NEEDS OF THE PATIENT.
9(2)   AN ENTITY SUBJECT TO THIS SECTION MAY NOT SUBSTITUTE ITS
10 OWN CLINICAL JUDGMENT FOR THAT OF THE TREATING PROVIDER IF THE
11 PROVIDER’S DETERMINATION IS CONSISTENT WITH ACCEPTED MEDICAL
12 STANDARDS.
13      (G)  AN ENTITY SUBJECT TO THIS SECTION SHALL ENSURE THAT COVERED
14 INDIVIDUALS HAVE TIMELY ACCESS TO HORMONE–RELATED CARE, INCLUDING:
15(1) ACCESS TO IN–NETWORK PROVIDERS WITH APPROPRIATE
16 EXPERTISE IN ENDOCRINE, REPRODUCTIVE, PERIMENOPAUSAL, AND MENOPAUSAL
17 CARE; AND
18(2)  COVERAGE FOR OUT–OF–NETWORK PROVIDERS IF IN–NETWORK
19 ACCESS IS UNAVAILABLE WITHIN A REASONABLE TRAVEL AREA.
20      (H)   (1) ON OR BEFORE JANUARY 1 EACH YEAR, BEGINNING IN 2028, EACH
21 ENTITY SUBJECT TO THIS SECTION SHALL REPORT TO THE ADMINISTRATION ON:
22(I)THE TOTAL NUMBER OF CLAIMS SUBMITTED FOR
23 HORMONE–RELATED CARE IN THE IMMEDIATELY PRECEDING YEAR, INCLUDING
24 CARE RELATED TO PERIMENOPAUSE AND MENOPAUSE;
25(II)
  THE TOTAL NUMBER OF CLAIMS DENIED AND THE REASONS
26 FOR DENYING THE CLAIMS; AND
27(III) THE AVERAGE AUTHORIZATION AND PROCESSING TIMES.
28(2)ON OR BEFORE JULY 1 EACH YEAR, BEGINNING IN 2028, THE
29 ADMINISTRATION SHALL SUBMIT TO THE GENERAL ASSEMBLY, IN ACCORDANCE
  HOUSE BILL 1435  5
1 WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, A REPORT SUMMARIZING
2 THE INFORMATION SUBMITTED UNDER PARAGRAPH (1) OF THIS SUBSECTION.
3(I)  THE ADMINISTRATION SHALL ADOPT REGULATIONS TO CARRY OUT
4 THIS SECTION.
5SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all
6 policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or
7 after January 1, 2027.
8      SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect
9 January 1, 2027.