Great news for patients with insurance coverage for prescriptions in Washington State!
A law has been passed and signed in Washington state that protects access to gender affirming medications and ensures health plan coverage of up to a year’s supply of meds picked up at one time. In a time of uncertainty, this can ease anxiety about access to meds and help patients plan for the future. This law goes into effect on January 1, 2026.
This does not change our ability to prescribe up to a year’s supply of meds (which we do when appropriate). It requires health insurance plans to cover the cost of picking up a year’s supply at one time.
The law: HB 1971
What it does: requires health plans in Washington to reimburse patients for 12-month refills of prescription hormone therapy medications.
The details:
- For health plans that are issued or renewed on or after Jan 1, 2026:
- That include coverage for gender affirming care prescriptions.
- Most insurance plans in Washington do cover gender affirming care.
- State-regulated plans are required to do so.
- Employer-funded plans are not required to do so.
- The health plan must provide reimbursement for a 12-month supply, UNLESS
- The patient requests a smaller amount.
- The prescriber prescribes a smaller amount.
- The medication is controlled or refrigerated.
- If the medication is controlled or refrigerated, the health plan must provide reimbursement for the maximum refill allowed under state and federal law.
- For TESTOSTERONE: a six-month supply is covered at one time.
- If the medication is controlled or refrigerated, the health plan must provide reimbursement for the maximum refill allowed under state and federal law.
This law does not apply to GLP-1 medications like Wegovy, Ozempic, Mounjaro, and Zepbound (these are diabetes and weight loss medications).
The definition of “prescription hormone therapy” includes all drugs approved by the FDA that are used to “medically suppress, increase, or replace hormones that the body is not producing at intended levels.” So this law does cover progesterone and blockers.
Health plans will be required to cover 12-month prescriptions starting January 1, 2026.
At QueerDoc, YES, we will provide a 6- or 12-month prescription if it is clinically appropriate to do so. We may still ask you to get labs done or maintain your appointment schedule with us during the time period covered by your prescription.
Not in Washington? We can write prescriptions for more than what insurance will cover, but the additional supply will need to be cash-pay. Have questions? Ask your QueerDoc provider at your next visit!
Other Information About Insurance And Insurance In Washington State
- 10/23 Is Insurance Required to Cover Gender Affirming Care in WA State?
- Washington State Protects Your Right To Gender Affirming Care (March 2025)
- What Does My Plan Cover? Health Insurance for Gender Affirming Care
Other Insurance and Prescription Resources
- Out2Enroll.org can help you find insurance that covers prescriptions for gender affirming care.
- Accessing Meds More Cost Effectively: What to Do When Insurance Denies Coverage (Oct 2024)
- Helpful Resources for Navigating Insurance
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