Menopause.

Section 2190.4(b) had a grammatical error corrected: 'Beginning July 1, 2026, a and until July 1, 2032' was changed to 'Beginning July 1, 2026, and until July 1, 2032.' This is a leftover article from prior editing that did not affect the meaning of the provision.

Standard enrolled-bill formatting changes: removal of amendment history header, addition of Assembly and Senate passage dates, removal of line numbers, page number renumbering from 93 to 92, and removal of a malformed coauthor line.

A new definition of 'qualifying physician and surgeon' is added to Section 2190.4(a). The term means a physician certified by the Medical Board who holds board certification through the American Board of Medical Specialties in one of eight specialties (general internist, family physician, obstetrician and gynecologist, cardiologist, endocrinologist, neurologist, or psychiatrist) AND whose patient population is at least 25 percent adult women under 65 years of age.

The double CME credit for menopause coursework (2 hours of credit per hour completed, capped at 8 course hours) now applies only to 'qualifying physicians and surgeons' as defined above, rather than to all physicians and surgeons. This substantially narrows the group eligible for the incentive.

A sunset date of July 1, 2032 is added to the CME credit provision. The double-credit incentive will be in effect from July 1, 2026 through July 1, 2032, after which it expires.

Senator Rubio is added as a coauthor alongside Senator Weber Pierson, indicating additional Senate sponsorship of the bill.

The mandatory 5-hour continuing medical education requirement in perimenopause, menopause, and postmenopausal care was deleted for both allopathic physicians (Section 2190.4) and osteopathic physicians (Section 2454.7). Previously, physicians with 25% or more adult women under 65 in their patient population were required to complete this training at license renewal after July 1, 2026, and every four years thereafter.

Coverage must now be provided 'without utilization management for treatments approved by the federal Food and Drug Administration,' creating a carve-out that exempts FDA-approved menopause treatments from prior authorization and other utilization management processes.

Each of the four required coverage categories (hormone therapy, nonhormonal medications, genitourinary syndrome treatment, osteoporosis prevention/treatment) now explicitly specifies 'outpatient prescription drug' as the type of coverage required.

The insurance coverage mandate for menopause evaluation and treatment is now limited to health care service plan contracts and health insurance policies that cover outpatient prescription drugs. Plans or policies without outpatient prescription drug coverage are no longer subject to the requirement.

Coverage language was changed from 'evaluation and treatment options for perimenopause and menopause' to 'evaluation and treatment options for symptoms of perimenopause and menopause,' potentially narrowing the scope of covered services to symptom-based care rather than broader conditions.

The determination of medical necessity is now tied to the treating provider's relationship with the plan or insurer: 'under contract with the health care service plan or in accordance with the contract if there is an out-of-network benefit' (and similar language for insurance policies).

Assembly Member Aguiar-Curry and Senator Weber Pierson were added as coauthors of the bill.

The definition of 'method of administration' was expanded to include 'rectal' as a route, alongside oral, topical, vaginal, subcutaneous, injectable, and intravenous routes.

A new subsection (g) was added to Section 4 (Health and Safety Code 1367.252) exempting Medi-Cal managed care plan contracts with the State Department of Health Care Services from the menopause coverage requirements. This means state-funded Medicaid plans are no longer required to include the specified perimenopause and menopause drug coverage.

The word 'vaginal' was removed from the definition of formulation type (E) in both Section 4 (Health and Safety Code) and Section 5 (Insurance Code), changing 'A vaginal suppository, cream, or silicone ring' to 'A suppository, cream, or silicone ring.' This broadens the definition slightly by not limiting those product types to vaginal administration.

Minor grammatical corrections: redundant commas were removed in the opening phrases of Sections 4 and 5 (e.g., 'contract, contract that covers' changed to 'contract that covers').

Changed the menopause CME requirement from 'at least 10% of all mandatory continuing medical education hours' to a flat 'at least 5 hours of mandatory continuing medical education' in perimenopause, menopause, and postmenopausal care courses. This applies to both MDs (Section 2190.4) and DOs (Section 2454.7).

Added a new double-credit provision for physicians and surgeons: those who complete CME courses in perimenopause, menopause, and postmenopausal care receive 2 hours of credit for each hour completed, capped at 8 course hours total, toward the requirement in Section 1336 of Title 16 of the California Code of Regulations. Effective July 1, 2026.

Added a parallel double-credit provision for osteopathic physicians and surgeons: same 2-for-1 credit structure capped at 8 course hours, toward the requirement in Section 1635 of Title 16 of the California Code of Regulations. Effective July 1, 2026.

Minor wording change to the patient population threshold: changed from '25% or more of adult women under 65 years of age' to '25 percent or more adult women under 65 years of age' (removed the word 'of').

New Section 2454.7 added to the Business and Professions Code (Osteopathic Act) requiring osteopathic physicians with 25% or more adult women under 65 in their patient population to complete five hours of CME on perimenopause, menopause, and postmenopausal care. Previously only MDs were covered.

The legislative digest now includes a new paragraph describing the Osteopathic Act and the bill's application to osteopathic physicians, reflecting the expanded scope of the CME requirement beyond just MDs.

The CME requirement was changed from 'at least 10 percent of all mandatory continuing medical education hours' to a fixed 'at least five hours of mandatory continuing medical education,' making the obligation more specific and predictable for affected physicians.

Section 2191(l) was deleted, which had required the Medical Board to include a course in menopausal mental or physical health when determining its CME requirements. This 'consider and include' approach was replaced by the direct physician-level mandate in Section 2190.4.

A compliance timeline was added: the requirement applies for the first license renewal after July 1, 2026, and every four years thereafter. The prior version had no specified start date or renewal cycle.

The physician CME requirement is narrowed from 'all physicians' to six specific specialties: general internists, family physicians, obstetricians and gynecologists, cardiologists, endocrinologists, and neurologists.

The patient population threshold changes from '25 percent or more of women' to '25 percent or more of adult women under 65 years of age,' excluding older patients from the count.

The CME requirement changes from completing 'a mandatory continuing medical education course' (unspecified duration) to completing 'at least 10 percent of all mandatory continuing medical education hours' in menopause-related content, providing a concrete minimum.

Section 2191(l) is changed from the board 'shall consider including' a course in menopausal mental or physical health to the board 'shall include' such a course, making it a mandatory requirement rather than a discretionary consideration.

Coauthors added: Assembly Members Boerner, Bonta, Lowenthal, Pellerin, and Stefani.