Menopause costs women sleep, work, and money. NJ may finally fix that

🌡A legal proposal focuses on menopausal and perimenopausal women

🌡A lawmaker wants to make insurance companies pay for services

🌡The bill calls for blanket insurance coverage for necessary treatments

TRENTON — A bill (A5278) moving through the Assembly would make insurance companies pay for all necessary menopause and perimenopause treatments in New Jersey.

Primary bill sponsor, Assemblywoman Heather Simmons, D-Gloucester, says about 6,000 women reach menopause in the United States every day, yet there is little support around it

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Terms of the bill

This bill is part of a menopause and perimenopause package. What makes this bill different from ones in other states is that this bill calls for blanket insurance coverage from all insurance carriers in New Jersey for perimenopause and menopause services and approved treatments, Simmons said.

The companion bill (A5309) calls for continuing education so providers have information about services and treatments for perimenopause and menopause, she added.

Hormone replacement therapy is the top procedure that would be covered under Simmons’ bill. Estrogen, progesterone, and testosterone are the three main hormones that need replacement during perimenopause and menopause.

Other procedures and services covered would be pelvic floor therapy, mental health therapy and counseling, bone health treatments including screenings, medications, and supplements due to hormonal changes, and things related to cancer prevention and cardiac health, Simmons explained.

“The fact is that a lot of these things, depending on your specific policy, are already covered by insurance. But this gives an opportunity for blanket coverage so there isn’t a gap in coverage and a woman’s wallet is dictating what care they pursue,” Simmons said.

Why the need for this bill?

Simmons made no secret that she is in menopause herself. She talked about how she lay awake at night experiencing night sweats attributed to the “change” and she would ask herself, “If this is a medical condition that affects more than half the population for up to half of our lives, then there should be more consistent coverage and options for treatment?”

Women missing work because of sickness and symptoms due to menopause and perimenopause cost the economy about $1.9 billion a year.

“I think we can do better than that,” Simmons said.

She said she would often get upset when she saw commercials on television for services and procedures covered for men, but women were left out.

“This is a matter of provider education, insurance coverage, and also the next steps are medical school education and trying to incorporate women more into medical research and physician education,” she said.

The big surprise

Simmons said she was pleasantly surprised to learn that the insurance carriers came out in favor of this bill. She was hoping for them to just be neutral. But, they not only came in favor of the bill, but the insurance carriers also testified in favor of the bill.
Last week, the bill went up before the Assembly Financial Institutions and Insurance Committee and passed unanimously, Simmons said.

The key takeaway

The New Jersey Legislature has the opportunity to be a national leader in terms of menopause treatments and services.

While many states have addressed coverage for specific services and treatments, this is the first bill that looks at blanket coverage in a universal way for women, Simmons said.

“It’s really meaningful for women, it addresses the needs of women at mid-life and beyond,” she said.

What’s next for the bill?

Hopefully, the next step is for the bill to be heard on the Assembly floor.
“My Senate partner, John Burzichelli actually has this bill in the Senate and he’s working with a number of committees to try and get this bill as well as his companion bill heard in the Senate, as well,” she said.

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