PrEP Access and Coverage Act of 2026

Key Points

• The bill requires nearly all health insurance plans — private, Medicare, Medicaid, CHIP, federal employee, VA, TRICARE, and Indian Health Service — to cover HIV prevention drugs (PrEP and PEP) and all related services at zero cost to patients. This includes the medication itself, lab tests, doctor visits, and clinical monitoring.
• Insurance companies would be banned from requiring prior authorization for PrEP drugs, removing a common bureaucratic hurdle that delays patients from starting prevention treatment. Plans could only require prior authorization if they already cover a therapeutically equivalent alternative without it.
• The bill makes it illegal for life, disability, or long-term care insurers to deny coverage, charge higher premiums, or discriminate against anyone for taking HIV prevention medication. Individuals harmed by violations can sue in federal court.
• Privacy protections would be updated so that people on a family insurance plan can access PrEP without other family members — including the primary policyholder — being notified, addressing a key barrier for young adults and others who fear stigma.
• A new federal grant program would fund states, tribes, and community health organizations to provide PrEP and PEP services to uninsured and underinsured people, alongside public education campaigns targeting communities disproportionately affected by HIV.
• Most coverage provisions would take effect for plan years beginning on or after January 1, 2027. The Medicaid and CHIP changes also target that date, with a delay allowed for states that need to pass new legislation first.

Votes

No votes have been recorded for this legislation yet.