Oregon Governor Signs Various Healthcare Bills into Law

Gov. Kotek signed the following healthcare bills into law. The state’s 2025 legislative session began on January 21 and adjourned on June 27. In Oregon, the default effective date for a recently passed law is January 1 of the following year, unless the law specifies otherwise.

• SB 598: Requires health insurance carriers to ensure that coverage for at least one clinically appropriate nonopioid prescription drug is available as an alternative for an opioid prescription drug. The legislation states that insurers must use the same utilization review requirements and cost-sharing provisions for opioid and nonopioid drugs when they are prescribed for the same treatment.
• SB 699: Mandates health insurance carriers to expand coverage of prosthetic and orthotic devices. The legislation amends the definition of a “device” to include a device determined to be medically necessary to restore or maintain the ability to complete activities of daily living or essential job-related activities that are not solely for comfort or convenience. It also amends the definition to include a replacement device or part, including for changes to the physiological condition of the insured.
• SB 822: Allows some health and dental plans to use remote providers (e.g., telemedicine) to meet network adequacy requirements. The legislation includes substance use disorder as well as reproductive healthcare and treatment in network adequacy considerations. Network adequacy also includes providing services in an appropriate and culturally competent manner to all enrollees, such as those with diverse cultural and ethnic backgrounds, varying sexual orientations and gender identities, disabilities or physical or mental health conditions. The bill prescribes additional rulemaking to help implement these network adequacy mandates.
• SB 1137: Requires health benefit plans to cover autologous breast reconstruction procedures and related inpatient/outpatient services. The legislation includes a requirement to ensure these services are available without unreasonable delay. If unable, carriers may not impose deductible, cost-sharing, or coinsurance that exceeds that of an in-network provider. The bill applies to plans issued, renewed, or extended on or after January 1, 2026.
• HB 2292: Requires health plans to cover more drugs approved by the United States Food and Drug Administration (FDA) for prevention and treatment of HIV without cost-sharing or prior authorization. This also includes services necessary for starting or continuing HIV prevention drugs, such as office visits, testing, vaccinations, and monitoring services. The legislation applies to insurers that offer health benefit plans that reimburse the cost of counseling, prevention services, or screening for sexually transmitted diseases.
• HB 2540: Mandates health insurers to credit any amount an enrollee pays directly to a provider toward out-of-pocket costs and deductibles in certain circumstances. This applies if an item or service is medically necessary, the enrollee doesn’t submit a claim to the insurer, and the amount paid to the healthcare provider is less than the average discounted rate for the item or service paid to an in-network healthcare provider with the same license. The bill requires insurers to develop a process to submit a claim for credit or to require an enrollee to use a system in place by the insurer to process/adjudicate claims for credit.
• HB 3064: Indicates that health benefit plans must cover treatment for perimenopause, menopause, and post-menopause. The definitions include hormone therapy and bioidentical hormones, among other treatments. However, the coverage required by the bill must be for drugs approved by the United States FDA. The bill applies to plans issued, renewed, or extended on or after January 1, 2026.

Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.

• SB 598: Relating to step therapy for nonopioids
• SB 699: Relating to medical devices
• SB 822: Relating to provider networks
• SB 1137: Relating to autologous breast reconstruction
• HB 2292: Relating to treatment of human immunodeficiency virus
• HB 2540: Relating to medical out-of-pocket costs
• HB 3064: Relating to health care coverage beginning at perimenopause