II 

118TH CONGRESS 

2D SESSION S. 5445 

To amend title XVIII of the Social Security Act to provide coverage of 

contraceptive items and services at no cost-sharing under the Medicare 

program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 5, 2024 

Ms. HASSAN (for herself, Ms. MURKOWSKI, Ms. DUCKWORTH, and Ms. COLLINS) introduced the following bill; which was read twice and referred to 

the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

coverage of contraceptive items and services at no costsharing under the Medicare program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Closing the Contracep5 tion Coverage Gap Act’’. 


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1 SEC. 2. PROVIDING COVERAGE OF CONTRACEPTIVE ITEMS 

2 AND SERVICES AT NO COST-SHARING UNDER 

3 THE MEDICARE PROGRAM. 

4 (a) PART B COVERAGE.— 

5 (1) IN GENERAL.—Section 1861 of the Social 

6 Security Act (42 U.S.C. 1395x) is amended— 

7 (A) in subsection (s)(2)— 

8 (i) in subparagraph (JJ), by inserting 

9 ‘‘and’’ after the semicolon at the end; and 

10 (ii) by adding at the end the following 

11 new subparagraph: 

12 ‘‘(KK) contraceptive items and services (as de13 fined in subsection (nnn)) furnished to individuals 

14 on or after January 1, 2026.’’; and 

15 (B) by adding at the end the following new 

16 subsection: 

17 ‘‘(nnn) CONTRACEPTIVE ITEMS AND SERVICES.— 

18 ‘‘(1) IN GENERAL.—The term ‘contraceptive 

19 items and services’ means items and services fur20 nished by a physician or practitioner (as defined in 

21 section 1842(b)(18)(C))— 

22 ‘‘(A) that— 

23 ‘‘(i) align with guidance as of January 

24 12, 2022, issued in accordance with in sec25 tion 2713(a)(4) of the Public Health ServVerDate Sep 11 2014 20:08 Dec 31, 2024 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5445.IS S5445

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1 ice Act (including patient-centered coun2 seling services); and 

3 ‘‘(ii) may be furnished for the purpose 

4 of contraception; or 

5 ‘‘(B) that are ancillary clinical services. 

6 ‘‘(2) ANCILLARY CLINICAL SERVICES.—For 

7 purposes of paragraph (1)(B), the term ‘ancillary 

8 clinical services’ means— 

9 ‘‘(A) clinical services that are related to 

10 the items and services described in paragraph 

11 (1)(A), including consultations, examinations, 

12 procedures, device insertion, ultrasound, pain 

13 management, patient education, referrals, and 

14 counseling; and 

15 ‘‘(B) follow-up services related to the pro16 vision or use of the items and services described 

17 in paragraph (1)(A), including management of 

18 side effects, counseling for continued adherence, 

19 and device removal. 

20 ‘‘(3) CLARIFICATION.—The term ‘contraceptive 

21 items and services’ includes items and services de22 scribed in paragraph (1) regardless of whether such 

23 items and services are actually furnished for pur24 poses of contraception. 


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1 ‘‘(4) PATIENT-CENTERED COUNSELING SERV2 ICES.—For purposes of paragraph (1)(A), the Sec3 retary shall issue guidance regarding the coverage of 

4 patient-centered counseling. Such guidance shall— 

5 ‘‘(A) align with guidance as of January 12, 

6 2022, issued in accordance with section 

7 2713(a)(4) of the Public Health Service Act.; 

8 and 

9 ‘‘(B) include the coverage of counseling to 

10 all patients on the full range of contraceptive 

11 items and services described in paragraph (1).’’. 

12 (2) PAYMENT.—Section 1833 of the Social Se13 curity Act (42 U.S.C. 1395l) is amended— 

14 (A) in subsection (a)(1)— 

15 (i) by striking ‘‘and’’ before ‘‘(HH)’’; 

16 and 

17 (ii) by inserting the following before 

18 the semicolon: ‘‘and (II) with respect to 

19 contraceptive items and services (as de20 fined in section 1861(nnn)), the amount 

21 paid shall be an amount equal to 100 per22 cent of the lesser of the actual charge for 

23 the items and services or the amount de24 termined under a payment basis deter25 mined appropriate by the Secretary’’; and 


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1 (B) in subsection (b), in the first sen2 tence— 

3 (i) by striking ‘‘, and (13)’’ and in4 serting ‘‘(13)’’; and 

5 (ii) by striking ‘‘1861(n)..’’ and in6 serting ‘‘1861(n) , and (14) such deduct7 ible shall not apply with respect to contra8 ceptive items and services (as defined in 

9 section 1861(nnn)).’’. 

10 (3) EXCLUSION MODIFICATION.—Section 

11 1862(a)(1) of the Social Security Act (42 U.S.C. 

12 1395y(a)(1)) is amended— 

13 (A) in subparagraph (O), by striking 

14 ‘‘and’’ at the end; 

15 (B) in subparagraph (P), by striking the 

16 semicolon and inserting ‘‘, and’’; and 

17 (C) by adding at the end the following new 

18 subparagraph: 

19 ‘‘(Q) in the case of contraceptive items and 

20 services (as defined in section 1861(nnn)), which are 

21 not furnished or ordered by a physician or practi22 tioner (as defined in section 1842(b)(18)(C));’’. 

23 (4) QUALITY MEASURES.—The Secretary of 

24 Health and Human Services may, for the purposes 

25 of ensuring quality in services, develop measures of 


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1 contraceptive counseling, care, and access, including 

2 but not limited to validated survey instruments. 

3 (b) PART C COST-SHARING FOR CONTRACEPTIVE

4 ITEMS AND SERVICES.— 

5 (1) IN GENERAL.—Section 1852(a)(1)(B) of the 

6 Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) 

7 is amended— 

8 (A) in clause (iv)— 

9 (i) by redesignating subclause (VIII) 

10 as subclause (IX); and 

11 (ii) by inserting after subclause (VII) 

12 the following new subclause: 

13 ‘‘(VIII) Contraceptive items and 

14 services (as defined in section 

15 1861(nnn)).’’; and 

16 (B) in clause (v), by striking ‘‘and (VI)’’ 

17 and inserting ‘‘(VI), and (VIII)’’. 

18 (2) EFFECTIVE DATE.—The amendments made 

19 by this subsection shall apply with respect to plan 

20 years beginning on or after January 1, 2026. 

21 (c) PART D COVERAGE AND COST-SHARING FOR

22 CONTRACEPTIVE DRUGS.— 

23 (1) COVERAGE.—Section 1860D–4(b)(3)(G) of 

24 the Social Security Act (42 U.S.C. 1395w– 

25 104(b)(3)(G)) is amended— 


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1 (A) in clause (ii)(I), by adding at the end 

2 the following new sentence: ‘‘Such identification 

3 shall include the drugs described in clause 

4 (iv)(VII).’’; and 

5 (B) in clause (iv), by adding at the end the 

6 following new subclause: 

7 ‘‘(VII) Covered part D drugs de8 scribed in guidelines issued pursuant 

9 to section 2713(a)(4) of the Public 

10 Health Service Act and that may be 

11 furnished for purposes of contracep12 tion (regardless of whether such drugs 

13 are actually furnished for purposes of 

14 contraception).’’. 

15 (2) COST-SHARING.—Section 1860D–2 of the 

16 Social Security Act (42 U.S.C. 1395w–102) is 

17 amended— 

18 (A) in subsection (b)— 

19 (i) in paragraph (1)(A), in the matter 

20 preceding clause (i), by striking ‘‘and (9)’’ 

21 and inserting ‘‘, (9), and (10)’’; 

22 (ii) in paragraph (2)(A), in the matter 

23 preceding clause (i), by striking ‘‘and (9)’’ 

24 and inserting ‘‘, (9), and (10)’’; 


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1 (iii) in paragraph (3)(A), in the mat2 ter preceding clause (i), by striking ‘‘and 

3 (9)’’ and inserting ‘‘(9), and (10)’’; and 

4 (iv) by adding at the end the following 

5 new paragraph: 

6 ‘‘(10) TREATMENT OF COST-SHARING FOR CON7 TRACEPTIVE DRUGS.—For plan years beginning on 

8 or after January 1, 2026, with respect to a covered 

9 part D drug that is described in guidelines issued 

10 pursuant to section 2713(a)(4) of the Public Health 

11 Service Act and that may be furnished for purposes 

12 of contraception (regardless of whether such drug is 

13 actually furnished for purposes of contraception)— 

14 ‘‘(A) the deductible under paragraph (1) 

15 shall not apply; and 

16 ‘‘(B) there shall be no coinsurance or other 

17 cost-sharing under this part with respect to 

18 such drug.’’; and 

19 (B) in subsection (c), by adding at the end 

20 the following new paragraph: 

21 ‘‘(7) TREATMENT OF COST-SHARING FOR CON22 TRACEPTIVE DRUGS.—The coverage is provided in 

23 accordance with subsection (b)(10).’’. 

24 (3) CONFORMING AMENDMENTS TO COST-SHAR25 ING FOR LOW-INCOME INDIVIDUALS.—Section 


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1 1860D–14(a) of the Social Security Act (42 U.S.C. 

2 1395w–114(a)) is amended— 

3 (A) in paragraph (1)(D), in each of clauses 

4 (ii) and (iii), by striking ‘‘paragraph (6)’’ and 

5 inserting ‘‘paragraphs (6) and (7)’’; 

6 (B) in paragraph (2)— 

7 (i) in subparagraph (B), by striking 

8 ‘‘and (9)’’ and inserting ‘‘, (9), and (10)’’; 

9 (ii) in subparagraph (D), by striking 

10 ‘‘paragraph (6)’’ and inserting ‘‘para11 graphs (6) and (7)’’; and 

12 (iii) in subparagraph (E), by striking 

13 ‘‘paragraph (6)’’ and inserting ‘‘para14 graphs (6) and (7)’’; and 

15 (C) by adding at the end the following new 

16 paragraph: 

17 ‘‘(7) NO APPLICATION OF COST-SHARING OR

18 DEDUCTIBLE FOR CONTRACEPTIVE DRUGS.—For 

19 plan years beginning on or after January 1, 2026, 

20 with respect to a covered part D drug that is de21 scribed in guidelines issued pursuant to section 

22 2713(a)(4) of the Public Health Service Act and 

23 that is furnished for purposes of contraception— 

24 ‘‘(A) the deductible under section 1860D– 

25 2(b)(1) shall not apply; and 


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1 ‘‘(B) there shall be no cost-sharing under 

2 this section with respect to such drug.’’. 

3 (4) EFFECTIVE DATE.—The amendments made 

4 by this subsection shall apply with respect to plan 

5 years beginning on or after January 1, 2026. 

6 (d) ENSURING COMPARABLE COVERAGE FOR DUAL

7 ELIGIBLE INDIVIDUALS.—In implementing the amend8 ments made by this section, the Secretary of Health and 

9 Human Services shall ensure that the coverage of contra10 ceptive items and services (as defined in section 

11 1861(nnn) of the Social Security Act (as added by sub12 section (a)) and covered part D drugs described in section 

13 1860D–4(b)(3)(G)(VII) of such Act (as added by sub14 section (c)(1)) with respect to individuals who are dually 

15 eligible for benefits under the Medicare program under 

16 title XVIII of such Act and for medical assistance under 

17 a State plan under title XIX of such Act (or a waiver of 

18 such plan) is at least as comprehensive as the coverage 

19 of such items and services and drugs for such individuals 

20 under such State plans (or waivers of such plans), as de21 termined by the Secretary based on an annual review of 

22 such State plans (and waivers of such plans). 


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1 SEC. 3. HHS STUDY AND REPORT ON PRESCRIPTION DRUG 

2 COVERAGE FOR MEDICARE BENEFICIARIES 

3 LIVING WITH DISABILITIES. 

4 (a) STUDY.—The Secretary of Health and Human 

5 Services (in this section referred to as the ‘‘Secretary’’) 

6 shall conduct a study on— 

7 (1) the adequacy of access to prescription drug 

8 coverage, including oral contraceptives, among Medi9 care beneficiaries living with disabilities who are en10 rolled under the original Medicare fee-for-service 

11 program under parts A and B of title XVIII of the 

12 Social Security Act (but not enrolled under part C 

13 or D of such title XVIII); and 

14 (2) providing coverage of over-the-counter con15 traceptive drugs under the Medicare program under 

16 such title XVIII with no cost-sharing. 

17 (b) REPORT.—Not later than 1 year after the date 

18 of enactment of this Act, the Secretary shall submit to 

19 Congress a report on the study conducted under sub20 section (a), together with recommendations for such legis21 lation and administrative action as the Secretary deter22 mines appropriate. 


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1 SEC. 4. GAO STUDY AND REPORT ON CONTRACEPTIVE COV2 ERAGE REQUIREMENTS UNDER COMMER3 CIAL AND PUBLIC HEALTH PLANS. 

4 (a) STUDY.—The Comptroller General of the United 

5 States (in this section referred to as the ‘‘Comptroller 

6 General’’) shall conduct a study on the forms of health 

7 insurance (including commercial plans and public health 

8 programs (including Medicaid, Medicare, and 

9 TRICARE)), that are not required by State or Federal 

10 law to do one or both of the following: 

11 (1) Cover all forms of contraception approved 

12 by the Food and Drug Administration. 

13 (2) Waive cost-sharing for such contraception. 

14 (b) REPORT.—Not later than 1 year after the date 

15 of enactment of this Act, the Comptroller General shall 

16 submit to Congress a report on the study conducted under 

17 subsection (a), together with recommendations for such 

18 legislation and administrative action as the Comptroller 

19 General determines appropriate. 

20 SEC. 5. GAO STUDY AND REPORT ON DIFFERENCE IN COV21 ERAGE OF CONTRACEPTIVE ITEMS AND 

22 SERVICES FOR DUAL ELIGIBLES. 

23 (a) STUDY.—The Comptroller General of the United 

24 States (in this section referred to as the ‘‘Comptroller 

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1 erage of contraceptive items and services for individuals 

2 who are dually eligible for Medicare and Medicaid benefits. 

3 (b) REPORT.—Not later than 2 years after the date 

4 of enactment of this Act, the Comptroller General shall 

5 submit to Congress a report on the study conducted under 

6 subsection (a), together with recommendations for such 

7 legislation and administrative action as the Secretary de8 termines appropriate. 

Æ 


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