Measure directs Banking and Insurance Department to examine carrier compliance under the New Jersey Menopause Coverage Act.
TRENTON, NJ – A measure introduced in the New Jersey Assembly would require the Department of Banking and Insurance (DOBI) to conduct a confidential review of how health insurance carriers are administering coverage for hormone replacement therapy under the state’s New Jersey Menopause Coverage Act. The bill, sponsored by Assemblywoman Heather Simmons (D-3), was introduced on February 24, 2026.
Key Points
- The bill directs DOBI to review how insurers are implementing hormone replacement therapy benefits.
- The review will examine authorization and coverage data under the New Jersey Menopause Coverage Act.
- DOBI must report its findings to the Legislature within six months of the bill’s effective date.
Confidential review to assess insurance compliance
Under Assembly Bill 4449, DOBI would perform a one-time confidential assessment of insurance carrier practices related to hormone replacement therapy coverage. The department would collect and analyze data on prior authorization requests, approvals, and denials, as well as step therapy exception outcomes as required by the Ensuring Transparency in Prior Authorization Act.
The review is designed to determine whether there has been an overall increase in coverage for hormone replacement treatments since the Menopause Coverage Act took effect in 2025. DOBI would also have the authority to request additional data from insurers as part of their ordinary business operations.
Report due within six months
The department must submit its conclusions to the Legislature within six months after the bill becomes law. Once the report is delivered, the act would expire automatically.
Assemblywoman Simmons said the measure is intended to provide oversight and ensure that insurance companies are fully complying with the intent of the Menopause Coverage Act, which mandates coverage for hormone therapy prescribed to manage menopause symptoms.
If enacted, the bill would take effect immediately, initiating DOBI’s review and data collection process leading to its legislative report later this year.
