PrEP and PEP are Prevention Act

Key Points

• This bill would require all major types of health insurance to cover FDA-approved HIV prevention drugs at zero cost to patients. This includes both PrEP (taken daily to prevent infection) and PEP (taken after a possible exposure), along with related lab work, counseling, and follow-up care.
• The no-cost coverage mandate applies broadly across private employer plans, individual marketplace plans, Medicare Part B and Part D, Medicaid, the Children's Health Insurance Program (CHIP), and the Federal Employees Health Benefits Program.
• For Medicare beneficiaries, the bill eliminates both coinsurance and the Part B deductible for HIV prevention services. Under Part D, it removes all cost-sharing and deductibles for HIV prevention drugs.
• Insurance companies would generally be banned from requiring prior authorization before covering these HIV prevention drugs, unless they offer a therapeutically equivalent alternative without prior authorization.
• Changes would take effect starting with the first plan year after the bill is signed into law, with a special allowance for states that need to pass new legislation to comply with the Medicaid and CHIP requirements.