Health care coverage: prescription hormone therapy and nondiscrimination.

Senator Menjivar's prescription hormone therapy legislation requires California health plans and insurers to cover up to 12 months of FDA-approved hormone therapy when prescribed by network providers, while establishing comprehensive protections against discrimination in healthcare coverage. The measure applies to commercial plans, Medi-Cal managed care, and health insurance policies issued or renewed after January 1, 2026.

The bill prohibits plans and insurers from imposing utilization controls or other medical management techniques that would limit hormone therapy supplies to less than 12 months when dispensed at one time. While patients may request smaller quantities and providers retain discretion over prescription amounts, plans cannot require formal coverage requests beyond standard pharmacy claims. The provisions specifically apply to hormone therapies that can be safely stored at room temperature.

Beyond expanding hormone therapy access, the legislation bars health plans and insurers from discriminating against enrollees based on race, color, national origin, age, disability, or sex - including gender identity, sex characteristics, and sexual orientation. Plans may not deny or limit healthcare services based on an individual's assigned sex at birth or gender identity, nor implement categorical exclusions for gender-affirming care. The Department of Managed Health Care and Department of Insurance maintain authority to enforce these requirements, while the Department of Health Care Services must issue implementation guidance for Medi-Cal plans.