PrEP Access and Coverage Act of 2026

Section 2713(a) of the Public Health Service Act (42 U.S.C. 300gg–13(a)) is amended—

(A) in paragraph (2), by striking; and and inserting a semicolon;

(B) in paragraph (3), by striking the period and inserting a semicolon;

(C) in paragraph (4), by striking the period and inserting; and;

(D) by striking paragraph (5);

(E) by adding at the end the following:; and

(5) any prescription drug approved by the Food and Drug Administration used for the prevention of HIV (other than a drug subject to preauthorization requirements consistent with section 2729A–11), administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation.

(F) by adding at the end of the flush text at the end the following: For the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009..

Section 1251(a)(4) of the Patient Protection and Affordable Care Act (42 U.S.C. 18011(a)(4)) is amended by adding at the end the following:

(v) Section 2713(a)(5) (relating to coverage without cost-sharing for prescription drugs for the prevention of HIV).

Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following:

A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(5), except that a plan or issuer may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of this Act if such plan or issuer provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.

Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following:

A group health plan or a health insurance issuer offering group health insurance coverage shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(5) of the Public Health Service Act, except that a plan or issuer may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of the Public Health Service Act if such plan or issuer provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.

The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 726 the following new item:

Chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end of subchapter B the following:

A group health plan shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(5) of the Public Health Service Act, except that a plan may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of the Public Health Service Act if such plan provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.

The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:

Section 8904 of title 5, United States Code, is amended by adding at the end the following:

(c) Any health benefits plan offered under this chapter shall include benefits for, and may not impose any cost-sharing requirements for any prescription drug approved by the Food and Drug Administration used for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation.

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by—

(A) in subsection (a)(4), by striking the semicolon at the end and inserting; and (G) HIV prevention services;; and

(B) by adding at the end the following new subsection:

For purposes of subsection (a)(4)(G), the term HIV prevention services means all prescription drugs used for the prevention of HIV acquisition, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines without limitation.

Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended—

(A) in section 1916, by inserting HIV prevention services described in section 1905(a)(4)(G), after section 1905(a)(4)(C), each place it appears; and

(B) in section 1916A(b)(3)(B), by adding at the end the following new clause:

(xv) HIV prevention services described in section 1905(a)(4)(G).

Section 1937(b)(7) of the Social Security Act (42 U.S.C. 1396u–7(b)(7)) is amended—

(A) in the paragraph heading, by inserting and HIV prevention services after supplies; and

(B) by striking includes for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section and inserting includes medical assistance for HIV prevention services described in section 1905(a)(4)(G), and includes, for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section.

Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended—

(A) in subsection (a), in the matter preceding paragraph (1), by striking and (8) and inserting (8), and (13); and

(B) in subsection (c), by adding at the end the following new paragraph:

Regardless of the type of coverage elected by a State under subsection (a), the child health assistance provided for a targeted low-income child, and, in the case of a State that elects to provide pregnancy-related assistance pursuant to section 2112, the pregnancy-related assistance provided for a targeted low-income pregnant woman (as such terms are defined for purposes of such section), shall include coverage of HIV prevention services (as defined in section 1905(ll)).

Section 2103(e)(2) of the Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended—

(A) in the paragraph heading, by inserting HIV prevention services, after treatment,; and

(B) by inserting HIV prevention services described in subsection (c)(13), before or for pregnancy-related assistance.

Subject to subparagraph (B), the amendments made by subsection (c) and this subsection shall take effect on January 1, 2027.

In the case of a State plan approved under title XIX or XXI of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirements before the 1st day of the 1st calendar quarter beginning after the close of the 1st regular session of the State legislature that ends after the 1-year period beginning with the date of enactment of this section. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of the session is deemed to be a separate regular session of the State legislature.

Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—

(I) in subparagraph (JJ), by striking and at the end;

(II) in subparagraph (KK), by inserting and at the end; and

(III) by adding at the end the following new subparagraph:

(LL) HIV prevention services (as defined in subsection (ooo));

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

The term HIV prevention services means—

(1) drugs or biologicals approved by the Food and Drug Administration for the prevention of HIV;

(2) administrative fees for such drugs;

(3) laboratory and other diagnostic procedures associated with the use of such drugs; and

(4) clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation.

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—

(i) by striking and (HH) and inserting (HH); and

(ii) by inserting before the semicolon at the end the following:, and (II) with respect to HIV prevention services (as defined in section 1861(ooo)), the amount paid shall be 100 percent of (i) except as provided in clause (ii), the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to such services under this part, and (ii) in the case of such services that are covered OPD services (as defined in subsection (t)(1)(B)), the amount determined under subsection (t).

The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended—

(i) by striking, and (13) and inserting (13); and

(ii) by striking 1861(n).. and inserting 1861(n), and (14) such deductible shall not apply with respect to HIV prevention services (as defined in section 1861(ooo)(1))..

The amendments made by this paragraph shall apply to items and services furnished on or after January 1, 2027.

Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended—

(i) in subsection (b)—

(I) in paragraph (1)(A), by striking and (9) and inserting, (9), and (10);

(II) in paragraph (2)—

(aa) in subparagraph (A), by striking and (9) and inserting, (9), and (10);

(bb) in subparagraph (C)(i), in the matter preceding subclause (I), by striking and (9) and inserting (9), and (10); and

(cc) in subparagraph (D)(i), in the matter preceding subclause (I), by striking and (9) and inserting (9), and (10);

(III) in paragraph (3)(A), in the matter preceding clause (i), by striking and (9) and inserting (9), and (10);

(IV) in paragraph (4)(A)(i), by striking and (9) and inserting, (9), and (10); and

(V) by adding at the end the following new paragraph:; and

For plan years beginning on or after January 1, 2027, with respect to a covered part D drug that is for the prevention of HIV—

(A) the deductible under paragraph (1) shall not apply; and

(B) there shall be no coinsurance or other cost-sharing under this part with respect to such drug.

(ii) in subsection (c), by adding at the end the following new paragraph:

The coverage is provided in accordance with subsection (b)(10).

Section 1860D–14(a) of the Social Security Act (42 U.S.C. 1395w–114(a)) is amended—

(i) in paragraph (1)(D), in each of clauses (ii) and (iii), by striking paragraph (6) and inserting paragraphs (6) and (7);

(ii) in paragraph (2)—

(I) in subparagraph (B), by striking and (9) and inserting, (9), and (10);

(II) in subparagraph (D), by striking paragraph (6) and inserting paragraphs (6) and (7); and

(III) in subparagraph (E), by striking paragraph (6) and inserting paragraphs (6) and (7); and

(iii) by adding at the end the following new paragraph:

For plan years beginning on or after January 1, 2027, with respect to a covered part D drug that is for the prevention of HIV—

(A) the deductible under section 1860D–2(b)(1) shall not apply; and

(B) there shall be no cost-sharing under this section with respect to such drug.

Section 1722A(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:

(5) Paragraph (1) does not apply to a medication for the prevention of HIV.

Section 1710 of such title is amended—

(A) in subsection (f)—

(i) by redesignating paragraph (5) as paragraph (6); and

(ii) by inserting after paragraph (4) the following new paragraph (5):; and

(5) A veteran shall not be liable to the United States under this subsection for any amounts for laboratory and other diagnostic procedures associated with the use of any prescription drug approved by the Food and Drug Administration and used for the prevention of HIV, administrative fees for such a drug, or clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation.

(B) in subsection (g)(3), by adding at the end the following new subparagraph:

(C) Any prescription drug approved by the Food and Drug Administration and used for the prevention of HIV, administrative fees for such a drug, laboratory and other diagnostic procedures associated with the use of such a drug, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation.

Section 1701(9) of such title is amended—

(A) in subparagraph (K), by striking; and and inserting a semicolon;

(B) by redesignating subparagraph (L) as subparagraph (M); and

(C) by inserting after subparagraph (K) the following new subparagraph (L):

(L) any prescription drug approved by the Food and Drug Administration and used for the prevention of HIV, administrative fees for such a drug, laboratory and other diagnostic procedures associated with the use of such a drug, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation; and

Chapter 55 of title 10, United States Code, is amended by inserting after section 1074o the following new section:

The Secretary of Defense shall ensure coverage under the TRICARE program of HIV prevention treatment described in subsection (b) for any beneficiary under section 1074(a) of this title.

HIV prevention treatment described in this subsection includes any prescription drug approved by the Food and Drug Administration and used for the prevention of HIV, administrative fees for such a drug, laboratory and other diagnostic procedures associated with the use of such a drug, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation.

Notwithstanding section 1075, 1075a, or 1074g(a)(6) of this title or any other provision of law, there is no cost-sharing requirement for HIV prevention treatment covered under this section.

The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1074o the following new item:

Title II of the Indian Health Care Improvement Act is amended by inserting after section 223 (25 U.S.C. 1621v) the following:

The Secretary, acting through the Director of HIV/AIDS Prevention and Treatment under section 832, shall provide, without limitation, funding for any prescription drug approved by the Food and Drug Administration for the prevention of human immunodeficiency virus (commonly known as HIV), administrative fees for that drug, laboratory and other diagnostic procedures associated with the use of that drug, and clinical follow-up and monitoring, including any related services recommended in current Public Health Service clinical practice guidelines, including policy notes updating those guidelines.

There are authorized to be appropriated such sums as are necessary to carry out this section.

The amendments made by subsections (a), (b), (e), (f), (g), and (h) shall take effect with respect to plan years beginning on or after January 1, 2027.

Notwithstanding any other provision of law, it shall be unlawful to—

(1) decline or limit coverage of an individual under any life insurance policy, disability insurance policy, or long-term care insurance policy, on account of the individual taking medication for the purpose of preventing the acquisition of HIV;

(2) preclude an individual from taking medication for the purpose of preventing the acquisition of HIV as a condition of receiving a life insurance policy, disability insurance policy, or long-term care insurance policy;

(3) consider whether an individual is taking medication for the purpose of preventing the acquisition of HIV in determining the premium rate for coverage of such individual under a life insurance policy, disability insurance policy, or long-term care insurance policy; or

(4) otherwise discriminate in the offering, issuance, cancellation, amount of such coverage, price, or any other condition of a life insurance policy, disability insurance policy, or long-term care insurance policy for an individual, based solely and without any additional actuarial risks upon whether the individual is taking medication for the purpose of preventing the acquisition of HIV.

A State insurance regulator may take such actions to enforce subsection (a) as are specifically authorized under the laws of such State.

In this section:

The term disability insurance policy means a contract under which an entity promises to pay a person a sum of money in the event that an illness or injury resulting in a disability prevents such person from working.

The term life insurance policy means a contract under which an entity promises to pay a designated beneficiary a sum of money upon the death of the insured.

The term long-term care insurance policy means a contract for which the only insurance protection provided under the contract is coverage of qualified long-term care services (as defined in section 7702B(c) of the Internal Revenue Code of 1986).

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, in consultation with the Director of the Office of Infectious Disease and HIV/AIDS Policy, shall establish a public health campaign for the purpose of educating the public on medication for the prevention of HIV acquisition.

In carrying out this subsection, the Secretary shall ensure cultural competency and efficacy within high-need communities in which PrEP or PEP are underutilized by developing the campaign in collaboration with organizations that are indigenous to communities that are overrepresented in the domestic HIV epidemic, including communities of color and the lesbian, gay, bisexual, transgender, and queer community. The Secretary shall ensure that the campaign is designed to increase awareness of the safety and effectiveness of PrEP and PEP, the recommended clinical practices for providing PrEP-related and PEP-related clinical care, and the local availability of PrEP and PEP providers, and to counter stigma associated with the use of PrEP and PEP.

The Secretary shall develop measures to evaluate the effectiveness of activities conducted under this subsection that are aimed at reducing disparities in access to PrEP and PEP and supporting the local community. Such measures shall evaluate community outreach activities, language services, workforce cultural competence, and other areas as determined by the Secretary.

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, and the Office of Infectious Disease and HIV/AIDS Policy, shall establish a provider campaign for the purpose of educating prescribers and other associated health professionals on medication for the prevention of HIV acquisition.

In carrying out this subsection, the Secretary shall increase awareness and readiness among health care providers to offer PrEP or PEP, as appropriate, with a focus on areas of high-need communities in which PrEP or PEP is underutilized by developing an educational campaign with input from health care providers and organizations from communities that are disproportionately affected by the domestic HIV epidemic, including communities of color and the lesbian, gay, bisexual, transgender, and queer community. The Secretary shall ensure that the campaign is designed to increase awareness of the safety and effectiveness of PrEP and PEP, the recommended clinical practices for providing PrEP-related and PEP-related clinical care, cultural competency among PrEP and PEP prescribers, and to counter stigma associated with the use of PrEP and PEP.

The Secretary shall develop measures to evaluate the effectiveness of activities conducted under this subsection that are aimed at increasing the number of health care professionals offering PrEP and PEP and reducing disparities in access to PrEP and PEP. Such measures shall evaluate availability of PrEP and PEP services, education and outreach activities, language services, workforce cultural competence, and other areas as determined by the Secretary.

In this section and section 399V–9—

(1) the term PEP means any drug or combination of drugs approved by the Food and Drug Administration for preventing HIV transmission after a sexual or other exposure associated with a high risk of HIV transmission; and

(2) the term PrEP means any drug approved by the Food and Drug Administration for the purpose of pre-exposure prophylaxis with respect to HIV.

To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2026 through 2030.

Not later than 1 year after the date of enactment of the PrEP Access and Coverage Act of 2026, the Secretary shall establish a program that awards grants to States, territories, Indian Tribes, and directly eligible entities for the establishment and support of pre-exposure prophylaxis (referred to in this section as PrEP) and post-exposure prophylaxis (referred to in this section as PEP) programs.

To be eligible to receive a grant under subsection (a), a State, territory, Indian Tribe, or directly eligible entity shall—

(1) submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan describing how any funds awarded will be used to increase access to PrEP for uninsured and underinsured individuals and reduce disparities in access to PrEP and PEP for uninsured and underinsured individuals and reduce disparities in access to PrEP and PEP; and

(2) appoint a PrEP and PEP grant administrator to manage the program.

For purposes of this section, the term directly eligible entity —

(1) means a nonprofit entity engaged in providing PrEP and PEP information and services; and

(2) may include—

(A) a Federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act);

(B) a family planning grantee (other than States) funded under section 1001;

(C) a rural health clinic (as defined in section 1861(aa)(2) of the Social Security Act);

(D) a health facility operated by or pursuant to a contract with the Indian Health Service;

(E) a community-based organization, clinic, hospital, or other health facility that provides services to individuals at risk for or living with HIV; and

(F) a nonprofit private entity providing comprehensive primary care to populations at risk of HIV, including faith-based and community-based organizations.

In determining whether to award a grant, and the grant amount for each grant awarded, the Secretary shall consider the grant application and the need for PrEP and PEP services in the area, the number of uninsured and underinsured individuals in the area, and how the State, territory, or Indian Tribe coordinates PrEP and PEP activities with the directly funded entity, if the State, territory, or Indian Tribe applies for the funds.

Any State, territory, Indian Tribe, or directly eligible entity that is awarded funds under subsection (a) shall use such funds for eligible PrEP and PEP expenses.

The Secretary shall publish a list of expenses that qualify as eligible PrEP and PEP expenses for purposes of this section, which shall include—

(A) any prescription drug approved by the Food and Drug Administration used for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, including policy notes updating those guidelines, without limitation;

(B) outreach and public education activities directed toward populations overrepresented in the domestic HIV epidemic that increase awareness about the existence of PrEP and PEP, provide education about access to and health care coverage of PrEP and PEP, PrEP and PEP adherence programs, and counter stigma associated with the use of PrEP and PEP;

(C) outreach activities directed toward physicians and other providers that provide education about PrEP and PEP; and

(D) adherence services and counseling, including personnel costs for PrEP navigators to retain patients in care.

The Secretary shall, in each of the first 5 years beginning 1 year after the date of enactment of the PrEP Access and Coverage Act of 2026, submit to Congress, and make public on the website of Department of Health and Human Services, a report on the impact of any grants provided to States, territories, Indian Tribes, and directly eligible entities for the establishment and support of pre-exposure prophylaxis programs under this section.

To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2026 through 2030.

The Secretary of Health and Human Services, in consultation with the Centers for Disease Control and Prevention, shall—

(1) issue guidance regarding the implementation of the coverage requirements established under this Act, including the amendments made by this Act, including with respect to implementation of such coverage requirements;

(2) develop and disseminate educational materials, including billing and coding documents based on stakeholder consensus-driven recommendations, as appropriate;

(3) provide technical assistance to State insurance commissioners;

(4) provide technical assistance to eligible entities regarding responding to consumer complaints and assisting in resolving such complaints; and

(5) work with other Federal agencies to assist in enforcement and compliance.

The Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury, in consultation with the Director of the Centers for Disease Control and Prevention, shall monitor compliance by group health plans and health insurance issuers with coverage requirements established under sections 2799A–11 of the Public Health Service Act, 726 of the Employee Retirement Income Security Act of 1974, and 9826 of the Internal Revenue Code of 1986 (as added by section 3(a)) and shall take appropriate enforcement actions under such Acts and such Code.

Beginning not later than 1 year after the date of enactment of this Act, each group health plan and health insurance issuer offering group or individual health insurance coverage shall submit to the Secretary of Health and Human Services, at such time as such secretary, in coordination with the Secretary of Labor and the Secretary of the Treasury, shall require, but not less frequently than annually for the 10-year period beginning on such date of enactment, data demonstrating compliance with the coverage requirements described in paragraph (1), including aggregate data on the number of claims received by such plans and issuers for HIV prevention services and the cost-sharing for enrollees with respect to such claims.

Not later than 2 years after the date of enactment of this Act and every 2 years thereafter for the 10-year period beginning on such date of enactment, the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury (collectively referred to in this section as the Secretaries) shall jointly submit to Congress and make publicly available a report to assess the prevalence of noncompliance with the coverage requirements described in paragraph (1). Each such report shall include—

(A) aggregate information about group health plans and health insurance issuers that the Secretaries determine to be out of compliance with such requirements; and

(B) steps the Secretaries have taken to address incidences of such noncompliance.

In this subsection, the terms group health plan, health insurance coverage, and health insurance issuer have the meanings given such terms in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91).