Saturday, July 13, 2024

Louisiana mandates insurance coverage for menopause, perimenopause treatment

by BIZ Magazine

BY: JULIE O’DONOGHUE – Louisiana Illuminator

Louisiana will require Medicaid and private health insurance plans to cover menopause and perimenopause treatment. The new law should ease access to hormone replacement therapy for those patients.

House Bill 392, sponsored by Rep. Aimee Freeman, D-New Orleans, goes into effect Aug. 1. She brought the legislation after local doctors complained they couldn’t get hormone replacement therapy covered by Medicaid for some of their patients experiencing menopause and perimenopause.

Menopause marks the end of menstrual cycles and typically occurs when people are in their 40s and 50s. It can come with a range of symptoms that disrupt sleep, cause changes in mood and create problems for their sex life, brain and bladder. It can also increase cholesterol and cause bone loss.

These symptoms crop up in perimenopause, a period preceding menopause that can last close to a decade and may start when a person is in their 30s. The issues make it difficult for some people to function at work and in their daily lives, but medical treatment can provide relief.

“Women spend 40% of their lives in menopause,” Freeman said in an interview. “There’s no reason someone has to live with brain fog.”

The Mayo Clinic says one of the most effective treatments for curbing troubling symptoms is hormone replacement therapy, medication that replaces the estrogen lost in the body while a person is in menopause and perimenopause.

A substitute for progesterone is also often needed and prescribed. Non-hormonal treatment, such as antidepressants, can also assist people.

Louisiana’s largest private insurer, Blue Cross and Blue Shield of Louisiana, already covers the menopausal and perimenopausal treatment mandated by Freeman’s legislation, according to a statement the organization provided last week.

A legislative fiscal analysis indicates Medicaid patients have only been able to access hormone replacement therapy with prior authorization, a process where health plans need to approve a medication before it is covered. Prior authorization is often used to deny coverage for treatment prescribed by doctors that the health care plan deems unnecessary or too expensive.

Under Freeman’s bill, Medicaid plans will no longer be able to require prior authorization for hormone replacement therapy.

Sen. Thomas Pressly, R-Shreveport, inserted language into the new law that prohibits health insurance plans from requiring prior authorization, step therapy or fail-first policies before offering hormone replacement therapy coverage to patients.

Like prior authorization, step therapy and fail-first policies often oblige a patient to try other, less expensive treatments before a health insurance company will cover the medication first prescribed by the doctor. In the case of perimenopause and menopause treatment, it could delay the use of hormone replacement therapy.

“Health insurers should be covering necessary and needed health care for women,” Pressly said.

The menopausal and perimenopausal law will go into effect without Gov. Jeff Landry’s signature. The governor’s office declined to say why he didn’t sign the legislation.

A small number of House Republicans also voted against the bill when it was approved 71-14. The Louisiana Senate voted 38-0 for the proposal.

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