§ 4077. Reproductive health care services
(a)(1) A health insurance plan shall provide coverage for outpatient contraceptive services, including sterilizations, and shall provide coverage for the purchase of all prescription contraceptives and prescription contraceptive devices approved by the U.S. Food and Drug Administration (FDA), except that a health insurance plan that does not provide coverage of prescription drugs is not required to provide coverage of prescription contraceptives and prescription contraceptive devices.
(2) A health insurance plan providing coverage required under this section shall not establish any rate, term, or condition that places a greater financial burden on a covered individual for access to contraceptive services, prescription contraceptives, and prescription contraceptive devices than for access to treatment, prescriptions, or devices for any other health condition.
(b) A health insurance plan shall provide coverage without any deductible, coinsurance, co-payment, or other cost-sharing requirement for at least one drug, device, or other product within each method of contraception for women identified by the FDA and prescribed by a covered individual’s health care professional.
(1) The coverage provided pursuant to this subsection shall include patient education and counseling by the covered individual’s health care provider regarding the appropriate use of the contraceptive method prescribed.
(2)(A) If there is a therapeutic equivalent of a drug, device, or other product for an FDA-approved contraceptive method, a health insurance plan may provide coverage for more than one drug, device, or other product and may impose cost-sharing requirements as long as at least one drug, device, or other product for that method is available without cost sharing.
(B) If a covered individual’s health care professional recommends a particular service or FDA-approved drug, device, or other product for the covered individual based on a determination of medical necessity, the health insurance plan shall defer to the health care professional’s determination and judgment and shall provide coverage without cost sharing for the drug, device, or product prescribed by the health care professional for the covered individual.
(c) A health insurance plan shall provide coverage for voluntary sterilization procedures for men and women without any deductible, coinsurance, co-payment, or other cost-sharing requirement, except to the extent that such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.
(d) A health insurance plan shall provide coverage without any deductible, coinsurance, co-payment, or other cost-sharing requirement for clinical services associated with providing the drugs, devices, products, and procedures covered under this section and related follow-up services, including management of side effects, counseling for continued adherence, and device insertion and removal.
(e)(1) A health insurance plan shall provide coverage for a supply of prescribed contraceptives intended to last over a 12-month duration, 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. The health insurance plan shall reimburse a health care provider or dispensing entity per unit for furnishing or dispensing a supply of contraceptives intended to last for 12 months.
(2) This subsection shall apply to Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State.
(f) Benefits provided under this section shall be the same for individuals covered under the health insurance plan.
(g) The coverage requirements of this section shall apply to self-administered hormonal contraceptives prescribed for a covered individual by a pharmacist in accordance with 26 V.S.A. § 2023.
(h)(1) As used in this subsection:
(A) “HIV prevention drug” means any preexposure prophylaxis drug or postexposure prophylaxis drug, including oral and long-acting injectable formulations, that is approved by the FDA for HIV prevention or that is otherwise authorized for HIV prevention pursuant to FDA labeling or federal clinical guidelines.
(B) “Supportive health service” means any health service that is necessary to monitor a patient to ensure the safe and effective ongoing use of an HIV prevention drug and includes:
(i) an office visit;
(ii) laboratory testing;
(iii) testing for a sexually transmitted infection;
(iv) medication self-management and adherence counseling;
(v) patient education and counseling by the patient’s health care provider regarding the appropriate use of the HIV prevention drug; and
(vi) any other health services that are components of comprehensive HIV prevention drug services as determined by the patient’s health care provider.
(2) A health insurance plan shall provide coverage for HIV preexposure prophylaxis drugs as recommended by the U.S. Preventive Services Task Force as of August 22, 2023. This coverage shall be provided without any deductible, coinsurance, co-payment, or other cost-sharing requirement, except to the extent that such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.
(3) Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State, except for any program funded in whole or in part by federal grants that include prohibitions on coverage of HIV prevention drugs, shall provide coverage of HIV prevention drugs and supportive health services and shall:
(A) not require any cost sharing, including co-payments;
(B) provide coverage without requiring prior authorization or any other protocol that may restrict or delay dispensing for at least one FDA-approved drug in each category of preexposure and postexposure prophylaxis drugs; and
(C) not deny coverage based on the type of health care professional issuing the prescription for any HIV prevention drug for which Medicaid does not require prior authorization, provided the health care professional is acting within the professional’s authorized scope of practice and is enrolled as a participating provider in Vermont Medicaid. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025; amended 2025, No. 120 (Adj. Sess.), § 10, eff. June 8, 2026.)