H.R. 7189 — PrEP Access Act

This section establishes coverage under Medicare Part B for pharmacist-provided HIV prevention services—defined as services and incident-to supplies furnished by a state-licensed pharmacist (that would otherwise be covered if furnished by a physician) related to HIV prevention, including evaluation, management, screening, consultation, counseling, medication administration for pre-exposure or post-exposure prophylaxis or other evidence-based interventions, and related clinical diagnostic laboratory tests—furnished on or after January 1, 2027. It provides payment from the Supplementary Medical Insurance Trust Fund equal to 80 percent of the lesser of the actual charge for the services or 85 percent of the physician fee schedule amount under Medicare Part B; requires participating pharmacists to accept assignment (i.e., prohibiting balance billing beyond the Part B coinsurance); and exempts such services from Part B's exclusion for items or services not reasonable and necessary for HIV prevention or detection.