HB 1827 — An Act providing for medical assistance coverage and insurance coverage of screening, prevention and treatment measures for osteoporosis as a result of menopause.

PRINTER'S NO.   2252

                   THE GENERAL ASSEMBLY OF PENNSYLVANIA



                       HOUSE BILL
                       No. 1827
                                                Session of
                                                  2025

     INTRODUCED BY SHUSTERMAN, HANBIDGE, HILL-EVANS, GUENST, SANCHEZ,
        HOWARD, RIVERA AND GALLAGHER, AUGUST 27, 2025

     REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 2, 2025


                                   AN ACT
 1   Providing for medical assistance coverage and insurance coverage
 2      of screening, prevention and treatment measures for
 3      osteoporosis as a result of menopause.
 4      The General Assembly of the Commonwealth of Pennsylvania
 5   hereby enacts as follows:
 6   Section 1.   Short title.
 7      This act shall be known and may be cited as the Earlier
 8   Insurance Coverage for Osteoporosis Treatments Act.
 9   Section 2.   Legislative findings.
10      The General Assembly finds that:
11          (1)   Many individuals experiencing menopause have a range
12      of signs and symptoms, which may include osteoporosis.
13          (2)   Osteoporosis may occur during menopause as a result
14      of lower estrogen levels in the body.
15          (3)   According to the Cleveland Clinic, throughout the
16      first five years of menopause, as much as 20% of bone loss
17      occurs.
18          (4)   Although the average age of women entering menopause
 1      in the United States is 51 years of age, bone density
 2      screenings are recommended for women over 65 years of age.
 3          (5)    Due to the lack of bone density screenings earlier
 4      in life, which would allow for more effective prevention and
 5      treatment measures before osteoporosis is more advanced and
 6      harder to treat, for most women, a bone fracture may be the
 7      first sign of osteoporosis.
 8          (6)    Among individuals with osteoporosis, vertebral or
 9      spine fractures, fractures in the forearm or wrist and hip
10      fractures are the most common.
11          (7)    Bone fractures related to osteoporosis that occur in
12      the spine or hip areas are especially concerning, as
13      mortality rates for older adults who have experienced a hip
14      fracture are significantly higher than those of older adults
15      who have not experienced a hip fracture.
16          (8)    Bone mineral density testing to measure the amount
17      of mineral in an individual's bones may be helpful in
18      screening for and diagnosing osteoporosis.
19          (9)    Osteoporosis medications can be used to slow or stop
20      the breakdown of bone or assist in the growth of new bone.
21          (10)    Nutritional supplements, increasing exercise and
22      strength training may also be helpful in reducing the effects
23      of osteoporosis and alleviating issues with bone density and
24      muscle pain.
25   Section 3.    Legislative purpose.
26      The purpose of this act is to provide coverage for
27   preventative measures, screenings and treatments for
28   osteoporosis beginning before or at the onset of menopause.
29   Section 4.    Definitions.
30      The following words and phrases when used in this act shall

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 1   have the meanings given to them in this section unless the
 2   context clearly indicates otherwise:
 3      "Bone mineral density testing."      An imaging test that
 4   measures the amount of mineral in a certain volume of bone,
 5   which is an indirect indicator of bone strength.
 6      "Cost-sharing."     The following:
 7          (1)   The share of the health care costs covered by a
 8      health insurance policy that an enrollee or covered person
 9      pays out of pocket.
10          (2)   The term includes a deductible, coinsurance,
11      copayment or similar charge.
12          (3)   The term does not include a premium, a balance
13      billed amount from an out-of-network provider or the cost of
14      a noncovered service.
15      "Department."   The Department of Human Services of the
16   Commonwealth.
17      "Dietary supplement."     A dietary supplement prescribed for
18   the maintenance or promotion of bone health.
19      "Health insurance policy."     As defined in section 2102 of the
20   act of May 17, 1921 (P.L.682, No.284), known as The Insurance
21   Company Law of 1921.
22      "Menopause."    The cessation of menstrual periods for 12
23   consecutive months, which can occur by a natural process of the
24   body or can be caused medically or surgically and may be
25   accompanied by any of the following symptoms:
26          (1)   Irregular menstrual periods.
27          (2)   Hot flashes.
28          (3)   Vaginal or bladder problems.
29          (4)   Decrease in fertility.
30          (5)   Loss of bone density, including osteoporosis.

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 1            (6)   Elevated low-density lipoprotein cholesterol levels.
 2            (7)   Sleep disruption, including night sweats.
 3      "Osteoporosis."     A disease characterized by loss of bone mass
 4   or structural deterioration, causing a decrease in bone strength
 5   and an increased risk of fractures.
 6   Section 5.     Duties of department.
 7      (a)   Medical assistance coverage.--Subject to Federal
 8   approval, the department shall provide medical assistance
 9   coverage for screenings and treatments for osteoporosis for
10   eligible and enrolled medical assistance recipients who have
11   reached menopause. The coverage required under this section
12   shall, at a minimum, include:
13            (1)   Coverage for bone mineral density testing.
14            (2)   Coverage for hormonal and nonhormonal treatments
15      used to treat menopausal symptoms, including osteoporosis.
16            (3)   Coverage for all drugs, devices and combination
17      products approved by the United States Food and Drug
18      Administration for the prevention or treatment of
19      osteoporosis.
20      (b)   State plan amendment or Federal waiver.--The department
21   shall seek a State plan amendment or Federal waiver from the
22   Centers for Medicare and Medicaid Services, if needed, for the
23   provision of the services listed in this section under the
24   medical assistance program.
25   Section 6.     Duties of insurers.
26      (a)   Coverage requirement.--A health insurance policy
27   offered, issued or renewed in this Commonwealth shall provide
28   coverage of preventative measures, testing and treatments for
29   osteoporosis for covered individuals who have reached menopause.
30   The coverage required under this section shall, at a minimum,

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 1   include:
 2            (1)   Coverage for bone mineral density testing.
 3            (2)   Coverage or reimbursement for preventative measures,
 4      including:
 5                  (i)    Dietary supplements.
 6                  (ii)    Weight training or personal training services.
 7                  (iii)    Physical therapy.
 8            (3)   Coverage for hormonal and nonhormonal treatments
 9      used to treat menopausal symptoms, including osteoporosis.
10            (4)   Coverage for all drugs, devices and combination
11      products approved by the United States Food and Drug
12      Administration for the prevention or treatment of
13      osteoporosis.
14      (b)     Terms and conditions.--The coverage required under this
15   section shall be subject to the terms and conditions of a health
16   insurance policy, including provisions relating to medical
17   necessity, cost-sharing and utilization review.
18      (c)     Condition.--Coverage may be conditioned upon the covered
19   individual receiving a prescription for the items under
20   subsection (a)(2).
21   Section 7.     Applicability.
22      This act shall apply as follows:
23            (1)   For a health insurance policy for which either rates
24      or forms are required to be filed with the Insurance
25      Department, this act shall apply to a policy for which a form
26      or rate is first filed on or after the effective date of this
27      paragraph.
28            (2)   For a health insurance policy for which neither
29      rates nor forms are required to be filed with the Insurance
30      Department, this act shall apply to a policy issued or

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1      renewed on or after 180 days after the effective date of this
2      paragraph.
3   Section 8.   Effective date.
4      This act shall take effect in 90 days.




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