§ 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. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)