An Act to Require Health Insurance Coverage for Federally Approved Nonprescription Oral Hormonal Contraceptives
Maine Legislature, Session 131, LD 2203
Committee Amendment CA_A_H958 (House)
Amends: 24 MRSA §2332-J, 24-A MRSA §2756, 24-A MRSA §2847-G, 24-A MRSA §4247, 24-A MRSA §4302

COMMITTEE AMENDMENT" A,, to H.P. 1411, L.D. 2203, "An Act to Require 
Health Insurance Coverage for Federally Approved Nonprescription Oral Hormonal 
Contraceptives" 
Amend the bill by striking out the title and substituting the following: 
'An Act to Require Health Insurance Coverage for Federally Approved 
Nonprescription Oral Hormonal Contraceptives and Nonprescription Emergency 
Contraceptives' 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec, 1. 24 MRSA §2332-J, sub-§1, as enacted by PL 1999, c. 341, §1 and affected 
by §5, is amended to read: 
1. Coverage requirements. All individual and group nonprofit hospital and medical 
services plan policies and contracts and all nonprofit health care plan policies and contracts 
that provide coverage for prescription drugs or outpatient medical services must provide 
coverage for all prescription contraceptives, nonprescription oral hormonal contraceptives 
and nonprescription emergency contraceptives approved by the federal Food and Drug 
Administration or for outpatient contraceptive services,-respectively, to the same extent 
that eoverage is provided for other preseription drugs m· outpatient medical services in 
accordance with the requirements of this section. For purposes of this section, the term 
"outpatient contraceptive services" means consultations, examinations, procedures and 
medical services provided on an outpatient basis and related to the use of contraceptive 
methods to prevent an unintended pregnancy. This section may not be construed to apply 
to prescription drugs or devices that are designed to terminate a pregnancy. 
Sec. 2. 24 MRSA §2332-J, sub-§4, as enacted by PL 2021, c. 609, § 1, is amended 
to read: 
4. Coverage of contraceptive supplies, Coverage required under this section must 
include coverage for contraceptive supplies in accordance with the following requirements. 
COMMITTEE AMENDMENT 
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COMMITIEEAMENDMENT"A" to H.P. 1411, L.D. 2203 
For purposes of this section, 
11contraceptive supplies" means all contraceptive drugs, 
devices and products approved by the federal Food and Drug Administration to prevent an 
unwanted pregnancy, including nonprescription oral horm9nal contraceptives and 
nonprescription emergency contraceptives. 
A. Coverage must be provided without any deductible, coinsurance, copayment or 
other cost-sharing requirement. 
B. If the federal Food and Drug Administration has approved one or more therapeutic 
equivalents of a contraceptive supply, an insurer is not required to cover all those 
therapeutically equivalent versions in accordance with this subsection, as long as at 
least one is covered without any deductible, coinsurance, copayment or other cost-
sharing requirement in accordance with this subsection. 
C. 
Coverage must be provided for the furnishing or dispensing of prescribed 
contraceptive supplies and nonprescription oral hormonal contraceptive supplies 
intended to last for a 12-month period, which may be furnished or dispensed all at once 
or over the course of the 12 months at the discretion of the health care provider. 
D. 
A prescription is not required to obtain a nonprescription oral hormonal 
contraceptive or nonprescription emergency contraceptive. 
E. A nonprofit hospital or medical service organization or nonprofit health care service 
organization shall establish mechanisms to ensure that an enrollee who seeks coverage 
for a nonprescription oral hormonal contraceptive or nonprescription emergency 
contraceptive at a pharmacy has the option either to obtain the nonprescription oral 
hormonal contraceptive or nonprescription emergency contraceptive at the point of sale 
without paymentof any cost sharing or to make the purchase at the pharmacy through 
an out-of-pocket payment at the point of sale and submit a claim for reimbursement. 
The pharmacy may use a standing order to facilitate billing for a nonprescription oral 
hormonal contraceptive or nonprescription emergency contraceptive in accordance 
with this paragraph. 
Sec. 3. 24 MRSA §2332-J, sub-§5 is enacted to read: 
5. 
Rules. 
The superintendent may adopt rules as necessary to implement the 
requirements of this section, including rules related to mechanisms to ensure coverage for 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives and rules regarding notice to enrollees about how to access coverage for 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives. Rules adopted pursuant to this section are routine technical rules as 
described in Title 5, chapter 375, subchapter 2-A. 
Sec, 4. 24-A MRSA §2756, sub-§1, as enacted by PL 1999, c. 341, §2 and affected 
by §5, is amended to read: 
1. Coverage requirements. All individual health policies and contracts, except 
accidental injury, specified disease, hospital indemnity, Medicare supplement, disability 
income, long-term care and other limited benefit health insurance policies and contracts, 
that provide coverage for prescription drugs or outpatient medical services must provide 
coverage for all prescription contraceptives, nonprescription oral hormonal contraceptives 
and nonprescription emergency contraceptives approved by the federal Food and Drug 
Administration or for outpatient contraceptive services, respectively, to the same extent 
COMMITTEE AMENDMENT 
0~ 
~ 
COMMITTEE AMENDMENT "A" to H.P. 1411, L.D. 2203 
that coverage is provided for other prescription drugs or outpatient medical services in 
accordance with the requirements of this section. For purposes of this section, the tel'm 
"outpatient contraceptive services" means consultations, examinations, procedures and 
medical services provided on an outpatient basis and related to the use of contraceptive 
methods to prevent an unintended pregnancy. This section may not be construed to apply 
to prescription drugs or devices that are designed to tenninate a pregnancy. 
Sec, 5. 24-A MRSA §2756, sub-§3, as amended by PL 2021, c. 609, §2, is fmther 
amended to read: 
3. Coverage of contraceptive supplies. Coverage required undel' this section must 
include coverage for contraceptive supplies in accordance with the following requirements. 
For purposes of this section, "contraceptive supplies" means all contraceptive drugs, 
devices and products approved by the federal Food and Drug Administration to prevent an 
unwanted pregnancy, including nonprescription oral hormonal contraceptives and 
nonprescription emergency contraceptives. 
A. Coverage must be provided without any deductible, coinsurance, copayment or 
other cost-sharing requirement. 
B. If the federal Food and Drug Administration has approved one or more therapeutic 
equivalents of a contraceptive supply, an insurer is not required to cover all those 
therapeutically equivalent versions in accordance with this subsection, as long as at 
least one is covered without any deductible, coinsurance, copayment or other cost-
sharing requirement in accordance with this subsection. 
D. 
Coverage must be provided for the furnishing or dispensing of prescribed 
contraceptive supplies and nonprescription oral hormonal contraceptive supplies 
intended to last for a 12-month period, which may be furnished or dispensed all at once 
or over the com·se of the 12 months at the discretion of the health care provider, 
E. 
A prescription is not required to obtain a nonprescription oral hormonal 
contraceptive or nonprescription emergency contraceptive. 
F. An insurer shall establish mechanisms to ensure that an enrollee who seeks coverage 
for a nonprescription oral hormonal contraceptive or nonprescription emergency 
contraceptive at a pharmacy has the option either to obtain the nonprescription oral 
hormonal contraceptive or nonprescription emergency contraceptive at the point of sale 
without payment of any cost sharing or to make the purchase through an out-of-pocket 
payment at the point of sale and submit a claim for reimbursement to the insurer. The 
pharmacy may use a standing order to facilitate billing for a nonprescription oral 
hormonal contraceptive or nonprescription emergency contraceptive in accordance 
with this paragraph. 
Sec, 6. 24-A MRSA §2756, sub-§4 is enacted to read: 
4. 
Rules, 
The superintendent may adopt rules as necessa1y to implement the 
requirements of this section, including rnles related to mechanisms to ensure coverage for 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives and rules regarding notice to enrollees about how to access coverage for 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives, Rules adopted pursuant to this section are routine technical rules as 
described in Title 5, chapter 375, subchapter 2-A. 
COMMITTEE AMENDMENT 
o<o 
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COMMITTEE AMENDMENT "A" to H.P. 1411, L.D. 2203 
Sec. 7. 24-A MRSA §2847-G, sub-§1, as enacted by PL 1999, c, 341, §3 and 
affected by §5, is amended to read: 
1. 
Coverage requirements. All group insurance policies and contracts, except 
accidental injury, specified disease, hospital indemnity, Medicare supplement, disability 
income, long-term care and other limited benefit health insurance policies and contracts 
that provide coverage for prescription drugs or outpatient medical services must provide 
coverage for all prescription contraceptives, nonprescription oral hormonal contraceptives 
and nonprescription emergency contraceptives approved by the federal Food and Drug 
Administration or for outpatient contraceptive services, respectively, to the same extent 
that coverage is provided for other prescription drugs or outpatient medical services in 
accordance with the requirements of this section. For purposes of this section, the term 
11outpatient contraceptive services'' means consultations, examinations, prncedures and 
medical services provided on an outpatient basis and related to the use of contraceptive 
methods to prevent an unintended pregnancy, This section may not be construed to apply 
to prescription drugs or devices that are designed to terminate a pregnancy, 
Sec. 8. 24-A MRSA §2847-G, sub-§4, as amended by PL 2021, c. 609, §3, is 
fmther amended to read: 
4. Coverage of contraceptive supplies. Coverage required under this section must 
include coverage for contraceptive supplies in accordance with the following requirements. 
For purposes of this section, "contraceptive supplies" means all contraceptive drugs, 
devices and products approved by the federal Food and Drug Administration to prevent an 
unwanted pregnancy, including nonprescription oral hormonal contraceptives and 
nonprescription emergency contraceptives, 
A. Coverage must be provided without any deductible, coinsurance, copayment or 
other cost-sharing requirement. 
B. If the federal Food and Drug Administration has approved one or more therapeutic 
equivalents of a contraceptive supply, an insurer is not required to cover all those 
therapeutically equivalent versions in accordance with this subsection, as long as at 
least one is covered without any deductible, coinsurance, copayment or other cost-
sharing requirement in accordance with this subsection. 
D. 
Coverage must be provided for the furnishing or dispensing of prescribed 
contraceptive supplies and nonprescription oral hormonal contraceptive supplies 
intended to last for a 12-month period, which may be furnished or dispensed all at once 
or over the course of the 12 months at the discretion of the health care provider. 
E. 
A prescription is not required to obtain a nonprescription oral hormonal 
contraceptive or nonprescription emergency contraceptive. 
F. An insurer shall establish mechanisms to ensure that an enrollee who seeks coverage 
for a nonprescription oral hormonal contraceptive or nonprescription emergency 
contraceptive at a pharmacy has the option either to obtain the nonprescription oral 
hormonal contraceptive or nonprescription emergency contraceptive at the point of sale 
without payment of any cost sharing or to make the purchase at the pharmacy through 
an out-of-pocket payment at the point of sale and submit a claim for reimbursement to 
the insurer. The pharmacy may use a standing order to facilitate billing for a 
COMMITTEE AMENDMENT 
o<2> 
~ 
COMMITTEE AMENDMENT 'A" to H.P. 1411, L.D. 2203 
nonprescription oral 
hormonal 
contraceptive or nonprescription emergency 
contraceptive in accordance with this paragraph. 
Sec, 9. 24-A MRSA §2847-G, sub-§5 is enacted to read: 
5. 
Rules, 
The superintendent may adopt rules as necessa1y to implement the 
requirements of this section, including rules related to mechanisms to ensure coverage for 
nonprescription 
oral 
ho11nonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives and rules regarding notice to enrollees about how to access coverage for 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives. Rules adopted pursuant to this section are routine technical rules as 
described in Title 5, chapter 375, subchapter 2-A. 
Sec. 10. 24-A MRSA §4247, sub-§1, as reallocated by RR 1999, c. 1, §37, is 
amended to read: 
1. Coverage requirements. All health maintenance organization individual and 
group health contracts that provide coverage for prescription drugs or outpatient medical 
services must provide coverage for all prescription contraceptives, nonprescription oral 
hormonal contraceptives and nonprescription emergency contraceptives approved by the 
federal Food and Drug Administration or for outpatient contraceptive services, 
respectively, to the same 63£tent that coverage is provided for other prescription drugs or 
outpatient medical services in accordance with the requirements of this section. For 
purposes of this section, the term "outpatient contraceptive services" means consultations, 
examinations, procedures and medical services provided on an outpatient basis and related 
to the use of contraceptive methods to prevent an unintended pregnancy. This section may 
not be construed to apply to prescription drugs or devices that are designed to terminate a 
pregnancy. 
Sec. 11. 24-A MRSA §4247, sub-§4, as amended by PL 2021, c. 609, §4, is further 
amended to read: 
4. Coverage of contraceptive supplies. Coverage required under this section must 
include coverage for contraceptive supplies in accordance with the following requirements, 
For purposes of this section, "contraceptive supplies" means all contraceptive drugs, 
devices and products approved by the federal Food and Drug Administration to prevent an 
unwanted pregnancy, including nonprescription oral hormonal contraceptives and 
nonprescription emergency contraceptives. 
A. Coverage must be provided without any deductible, coinsurance, copayment or 
other cost-sharing requirement. 
B. If the federal Food and Drug Administration has approved one or more therapeutic 
equivalents of a contraceptive supply, a health maintenance organization is not required 
to cover all those therapeutically equivalent versions in accordance with this 
subsection, as long as at least one is covered without any deductible, coinsurance, 
copayment or other cost-sharing requirement in accordance with this subsection, 
D. 
Coverage must be provided for the furnishing or dispensing of prescribed 
contraceptive supplies and nonprescription ornl hormonal contraceptive supplies 
intended to last for a 12-month period, which may be furnished or dispensed all at once 
or over the course of the 12 months at the discretion of the health care provider. 
COMMITTEE AMENDMENT 
~o<o 
COMMITTEE AMENDMENT. "A" to H.P. 1411, L.D. 2203 
E. 
A prescription is not required to obtain a nonprescription oral hormonal 
contraceptive or nonprescription emergency contraceptive. 
F. A health maintenance organization shall establish mechanisms to ensure that an 
emollee who seeks coverage for a nonprescription oral hormonal contraceptive or 
nonprescription emergency contraceptive at a pharmacy has the option either to obtain 
the nonprescription oral hormonal contraceptive or nonprescription emergency 
contraceptive at the point of sale without payment of any cost sharing or to make the 
purchase at the pharmacy through an out-of-pocket payment at the point of sale and 
submit a claim for reimbursement to the health maintenance organization. The 
pharmacy may use a standing order to facilitate billing for a nonprescription oral 
hormonal contraceptive or nonprescription emergency contraceptive in accordance 
with this paragraph. 
Sec. 12. 24-A MRSA §4247, sub-§5 is enacted to read: 
5. 
Rules. 
The superintendent may adopt rules as necessa1y to implement the 
requirements of this section, including rules related to mechanisms to ensure coverage for 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives and rules regarding notice to enrollees about how to access coverage for 
nonprescription 
oral 
ho11nonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives. Rules adopted pursuant to this section are routine technical rules as 
described in Title 5, chapter 375, subchapter 2-A. 
Sec. 13. 24-A MRSA §4302, sub-§1, 1A, as amended by PL 2009, c. 439, Pt. A, 
§2, is fmther amended to read: 
A. Coverage provisions, benefits and any exclusions by category of service, type of 
provider and, if applicable, by specific service, including but not limited to the 
following types of services, exclusions and limitations: 
(1) Health care services excluded from coverage; 
(2) Health care services requiring copayments or deductibles paid by enrollees; 
(3) Restrictions on access to a particular provider type; 
(4) Health care services that are or may be provided only by referral; ffila 
(5) Childhood immunizations as recommended by the United States Depaitment 
of Health and Human Services, Centers for Disease Control and Prevention and 
the American Academy of Pediatrics; and 
(6) Coverage requirements for contraceptive supplies and the procedures an 
enrollee must follow to access coverage for over-the-counter contraceptive 
supplies and nonprescription contraceptives at a pha11nacy without an out-of-
pocket cost at the point of sale or by submitting a claim for reimbursement; 
Sec. 14. Application. This Act applies to all policies, contracts and ce1tificates 
executed, delivered, issued for delivery, continued or renewed in this State on or after 
January 1, 2025. For purposes of this Act, all contracts are deemed to be renewed no later 
than the next yearly anniversary of the contract date. 
Sec. 15. Department of Professional and Financial Regulation, Bureau of 
Insurance review. The Depa1tment of Professional and Financial Regulation, Bureau of 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A" to H.P. 1411, L.D. 2203 
Insurance shall monitor compliance of health insurance carriers with the requirements for 
coverage of nonprescription oral hormonal contraceptives and nonprescription emergency 
contraceptives set fo1th in this Act and any rules adopted by the bureau to implement the 
requirements of this Act, including any complaints or barriers to implementation. The 
bureau shall also review any federal guidance developed in response to the "Request for 
Information" regarding a proposed rule to extend the application of the preventive services 
requirements under Section 2713 of the federal Public Health Service Act to over-the-
counter preventive items and services available without a prescription by a health care 
provider, including contraceptive supplies, No later than March 1, 2026, the bureau shall 
provide a rep01t to the joint standing committee of the Legislature having jurisdiction over 
health coverage, insurance and financial services matters with an update on implementation 
of the requirements of this Act, including recommendations for legislation to improve 
implementation, and on the status of any proposed federal rules related to coverage of 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription 
emergency 
contraceptives by health insurance carriers. The joint standing committee of the Legislature 
having jurisdiction over health coverage, insurance and financial services matters may 
repo1t out legislation based on the report to the Second Regular Session of the 132nd 
Legislature.' 
Amend the bill by relettering or renumbering any nonconsecutive Pait letter or section 
number to read consecutively. 
SUMMARY 
This amendment, which is the majority report of the committee, replaces the bill and 
changes the title. The amendment expands the requirements in current law for coverage of 
contraceptives 
to 
include 
nonprescription 
oral 
hormonal 
contraceptives 
and 
nonprescription emergency contraceptives approved by the federal Food and Drug 
Administration, The amendment provides that a prescription is not required for insurance 
coverage for nonprescription oral hormonal contraceptives and nonprescription emergency 
contraceptives and requires insurers to establish mechanisms to ensure that an enrollee who 
purchases a nonprescription oral ho11nonal contraceptive or nonprescription emergency 
contraceptive at a pharmacy has the option either to make the purchase pursuant to a 
standing order issued for billing purposes without a payment required at the point of sale 
or to make the purchase with a payment at the point of sale and submit a claim for 
reimbursement to the insurer, The requirements apply beginning January 1, 2025, 
The amendment requires health insurance carriers to notify enrollees, at least ammally, 
of the coverage requirements for contraceptive supplies and the procedures an enrollee 
must follow to access coverage for nonprescription oral honnonal contraceptives and 
nonprescription emergency contraceptives at a pharmacy without an out-of-pocket cost at 
the point of sale or by submitting a claim for reimbursement. The amendment also 
authorizes the Depa1tment of Professional and Financial Regulation, Bureau of Insurance 
to adopt rules to implement the provisions and also requires the bureau to monitor 
implementation by health insurance caniers and to repo1t to the joint standing committee 
of the Legislature having jurisdiction over health coverage, insurance and financial services 
matters no later than March 1, 2026, 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 04/09/24 feae 
LD 2203 
LR 3018(02) 
An Act to Require Health Insurance Coverage for Federally Approved Nonprescription Oral 
Hormonal Contraceptives 
Fiscal Note for Bill as Amended by Committee Amendment A ( H--9) t) 
Committee: Health Coverage, Insurance and Financial Services 
Net Cost (Savings) 
General Fund 
Highway Fund 
Appropriations/ Allocations 
General Fund 
Highway Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2023-24 
$0 
$0 
$0 
$0 
FY2024-25 
$0 
$0 
$0 
$0 
Projections 
FY 2025-26 
$69,758 
$25,745 
$69,758 
$25,745 
Projections 
FY 2026-27 
$69,758 
$25,7 
$69,758 
$25,745 
The bill requires the State Employee Health Plan to cover nonprescription oral honnonal contraceptives and 
nonprescription emergency contraceptives approved by the federal Food and Drng Administration. 
The requirements of the bill apply to health plans issued or renewed on or after January 1, 2025. The State Employee 
Health Plan's first impacted plan year will be fiscal year 2025-26 and is estimated to cost $154,507 a1mually 
thereafter. The costs are split across the General Fund ($69,758), Highway Funds ($25,745) and all other funds 
($59,004). 
LR3018(02) - Fiscal Note - Page 1 of 1