Bill would mandate no-cost PrEP coverage across insurers

What does this do?

This bill would require nearly all U.S. health insurance programs to cover FDA-approved HIV prevention medications, known as PrEP and PEP, along with related lab tests, doctor visits, and follow-up care at no cost to the patient. Plans generally could not require prior approval before covering these services, though they may require prior approval for a specific brand-name drug as long as a no-prior-approval alternative is available. The bill also makes it illegal for life, disability, or long-term care insurers to deny coverage or charge higher premiums to someone simply because they take HIV prevention medication.

Who does it affect?

This bill affects people enrolled in private insurance, Medicare, Medicaid, CHIP, the Federal Employees Health Benefits Program, VA health care, and TRICARE. People who are uninsured or underinsured may also be reached through grants awarded to states, tribes, and nonprofit organizations.

Why does it matter?

If insurers or other covered entities violate the bill's requirements, people who are harmed could sue in federal court and, if they win, have their legal costs covered by the defendant. Without this bill, current coverage of HIV prevention medications and related care would remain inconsistent across insurance programs.

What does it cost, and who pays?

• Funds public education campaigns
• Grants to states, tribes, nonprofits
• No specific amounts named