Bill
SB 5498
Expands 12-month contraception drug reimbursement from refills to all prescriptions; plans must cover a 12-month supply and allow on-site dispensing starting in 2026.
Status and timeline
- Effective date: January 1, 2026
- Enacted: Chapter 147, 2025 Laws (signed by Governor on April 22, 2025)
- Introduced: January 27, 2025
- Key legislative action: Passed both chambers and enacted into law in 2025
What the bill does (main purpose)
- Expands the 12-month supply reimbursement rule for contraceptives from only refills to all prescriptions.
- Maintains existing requirements that contraceptive drugs be covered by health plans without cost sharing and that enrollees have access to contraceptives on-site at the provider’s office when available.
- Establishes that contraception drugs include all FDA-approved medicines used to prevent pregnancy, across oral, transdermal, and intravaginal forms.
Key provisions
- Reimbursement scope: Health benefit plans issued or renewed on or after January 1, 2026 must reimburse a 12-month supply of contraceptive drugs obtained at one time by the enrollee for any prescription, unless the enrollee requests a smaller supply or the prescribing provider instructs a smaller supply.
- On-site access: Plans must allow enrollees to receive contraceptive drugs on-site at the provider’s office, if available.
- Dispensing practices: Plans must follow clinical guidelines to ensure appropriate prescribing and dispensing while maximizing access to effective contraceptive drugs.
- Last-quarter exemptions: Nothing in the bill prevents limiting refills that may be obtained in the last quarter of the plan year if a 12-month supply has already been dispensed in that year.
- Definitions: “Contraceptive drugs” means all FDA-approved drugs used to prevent pregnancy, including hormonal options administered orally, transdermally, and intravaginally.
Who is affected
- Health plans: Requires updated compliance to reimburse 12-month supplies for all contraceptive prescriptions (not just refills) starting in 2026.
- Enrollees/patients: Beneficiaries of these health plans gain broader access to longer-duration contraceptive prescriptions with reduced need for repeated dispensing within a year.
- Healthcare providers: Can prescribe longer-duration supplies and offer on-site dispensing when available, aligning with clinical guidelines.
Fiscal and appropriations
- Appropriation: None
- Fiscal note: Not requested
Context and public input
- Background: Builds on existing policy that contraceptive drugs are covered without cost sharing; previously, the 12-month supply requirement applied only to refills.
- Public testimony: Support cited the ability for individuals to determine prescription duration with their provider and noted relevance for survivors of domestic violence and students; no opposition reported.
Official status and references
- Final enacted text amended RCW 48.43.195 to implement the 12-month supply requirement for all prescriptions starting 2026, with a 2-year transition from introduction to enactment reflecting the legislative process.
Compiled from official sources — confirm details with the bill’s official record.
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