Menopause.

Assembly Member Bauer-Kahan advances a two-pronged approach to menopause care that ties clinician education to patient access, pairing a dedicated education incentive for physicians with a new coverage mandate for outpatient menopause therapies. The proposal creates a pathway for qualifying physicians and many obstetrician–gynecologists, internists, and other specialists to earn extra continuing medical education credit for completing perimenopause, menopause, and postmenopausal care coursework, available from mid-2026 through mid-2032, with a limit of eight total credit hours. Parallelly, osteopathic physicians receive matching credit, ensuring parity across the physician workforce. On the coverage side, health care service plans and health insurers would be required to cover evaluation and treatment options for perimenopause and menopause symptoms in outpatient prescription drug benefits issued, amended, or renewed on or after January 1, 2026, and plans must annually provide current clinical care recommendations for hormone therapy to contracted primary care providers treating patients with these conditions. The measure excludes Medi-Cal managed-care plans from these coverage requirements.

Key mechanisms underpinning the proposal include a precise definition of “qualifying physician and surgeon” for the CME credit: physicians licensed and board-certified in specified specialties, with at least a quarter of their patient population comprising adult women under 65. The CME credit itself would grant two hours of credit for each hour of menopause-related coursework, up to eight hours, applied toward the state continuing education requirements. In addition, the bill requires osteopathic physicians to receive the same credit structure, aligning MD and DO incentives within a coordinated CME framework. The bill also preserves a broad set of continuing education topics for physicians, with the explicit menopause focus delivered through the new incentive rather than a mandated menopause education requirement within the existing CE topics list.

The health coverage provisions establish a defined menu of drug-coverage expectations and related safeguards. For health care service plans and health insurers, the bill requires coverage for a range of options, including FDA-approved systemic hormone therapies in all formulations and administration methods, nonhormonal medications for each menopause symptom, treatments for genitourinary syndrome of menopause, and osteoporosis-preventive or -treating medications, with no utilization management for FDA-approved therapies. Providers must be able to adjust drug doses consistent with clinical recommendations, and all contracted primary care providers must receive annual clinical care recommendations from the Menopause Society or other recognized organizations, with plans encouraged to review those guidelines. Definitions cover the full spectrum of formulations and administration methods, and coverage is to be non-discriminatory with respect to gender expression or identity. The coverage requirements explicitly do not apply to Medi-Cal managed care contracts, and the enforcement framework contemplates criminal penalties for willful violations by a health care plan under the state’s Knox-Keene framework, with oversight by the appropriate regulatory bodies.

Beyond the core changes, the measure embeds implementation details and context: coverage and guidance provisions apply to policies issued, amended, or renewed after January 1, 2026, and the CME incentives run through July 2032. There is a formal recognition that no local reimbursements are required for implementing these changes, and enforcement mechanisms would involve the relevant state departments responsible for managed care and insurance, alongside medical and osteopathic licensing boards. The bill’s design situates menopause care within existing regulatory architectures—educational incentives aligned with physician practice patterns and payer-driven coverage requirements—while specifying exclusions and definitions to clarify scope and applicability. The overall framework aims to standardize access to menopause-related therapies across plans and insurers, integrate up-to-date clinical guidance for providers, and support a targeted education pathway for physicians serving sizable populations of adult women.