Health care coverage: prescription hormone therapy and nondiscrimination.

Senator Menjivar's prescription hormone therapy coverage bill requires health plans, insurers and Medi-Cal to cover up to 12-month supplies of FDA-approved hormone therapies while establishing broad nondiscrimination protections in healthcare coverage. The legislation mandates that health plans and insurers cover a full year's supply of prescribed hormone therapy and necessary self-administration supplies when dispensed at one time, prohibiting utilization controls that would limit quantities below 12 months.

The bill directs pharmacists to dispense up to 12-month supplies upon request, with exceptions if patients request less, providers specify smaller quantities, temporary shortages exist, or the medication is a controlled substance. Coverage requirements apply only to hormone therapies that can be safely stored at room temperature. While providers are not required to prescribe 12 months at once, plans and insurers cannot impose restrictions resulting in smaller supplies being dispensed.

Comprehensive nondiscrimination provisions prohibit health plans and insurers from limiting enrollment, benefits or coverage based on race, color, national origin, age, disability, or sex - with sex discrimination explicitly defined to include gender identity, sex characteristics, sexual orientation, and pregnancy. Plans must incorporate these protections into coverage documents and establish clear grievance procedures. The Medi-Cal provisions require federal approval before implementation, and managed care plans are exempt from the supply requirements. The coverage mandates sunset in 2035, while the nondiscrimination protections remain permanent.