H.R. 7853 — PrEP Access and Coverage Act of 2026

This section states the sense of Congress that the Department of Labor, the Department of Health and Human Services, and the Department of the Treasury should ensure compliance with the requirements of this Act.

This section amends the Public Health Service Act (PHSA), Patient Protection and Affordable Care Act (ACA), Employee Retirement Income Security Act (ERISA), Internal Revenue Code (IRC), title 5 U.S. Code (Federal Employees Health Benefits (FEHB) program), and Social Security Act (Medicaid) to require coverage without cost-sharing for prescription drugs approved by the Food and Drug Administration (FDA) for HIV prevention (i.e., pre-exposure prophylaxis (PrEP)), administrative fees, laboratory and diagnostic procedures, and clinical follow-up and monitoring per U.S. Public Health Service guidelines. Specifically, the section— (1) adds these services as a no-cost-sharing preventive benefit under PHSA §2713(a)(5) and applies the requirement to grandfathered health plans under ACA §1251; (2) prohibits preauthorization requirements for these services under PHSA part D (new §2799A–12), ERISA (new §727), and IRC (new §9827), except if the plan or issuer covers a therapeutically equivalent drug without preauthorization; (3) requires FEHB plans to cover these services without cost-sharing (new 5 U.S.C. §8904(c)); and (4) designates these services as a mandatory Medicaid benefit (SSA §1905(a)(4)(G) and (ll)). The section further specifies that current U.S. Preventive Services Task Force recommendations on breast cancer screening, mammography, and prevention exclude those issued in or around November 2009.

This section prohibits life, disability, and long-term care insurers from denying or limiting coverage, precluding use of HIV prevention medication as a coverage condition, increasing premiums, or otherwise discriminating against individuals based solely on their use of such medication (i.e., pre-exposure prophylaxis or PrEP). State insurance regulators enforce the prohibition under applicable state law.

This section establishes public and provider education campaigns on pre-exposure prophylaxis (PrEP)—FDA-approved drugs to prevent HIV before exposure—and post-exposure prophylaxis (PEP)—FDA-approved drugs to prevent HIV after high-risk exposure—under a new section 399V–8 of Part P of title III of the Public Health Service Act. (1) The public campaign, led by the CDC Director in consultation with the Office of Infectious Disease and HIV/AIDS Policy, targets underutilized high-need communities (e.g., communities of color and LGBTQ+ populations) to increase awareness of PrEP/PEP safety and effectiveness, clinical practices, provider availability, and to counter stigma, with required cultural competency, collaboration with indigenous organizations, and evaluation measures for reducing access disparities. (2) The provider campaign, led by the CDC Director, HRSA Administrator, and Office of Infectious Disease and HIV/AIDS Policy, educates prescribers and health professionals in high-need areas, with input from affected communities, to boost readiness, cultural competency, and PrEP/PEP provision while countering stigma, and includes evaluation measures for increasing service availability and reducing disparities. The section authorizes appropriations of such sums as necessary for FY2026 through FY2030.

This section directs the Secretary of Health and Human Services to amend HIPAA privacy regulations, as necessary, to ensure that individuals enrolled in a family health plan can access women's preventive health services required under section 2713(a)(5) of the Public Health Service Act—i.e., those recommended by the Health Resources and Services Administration, including contraceptives—without notifying other enrollees, including the primary subscriber or policyholder. (Thus, this protects the privacy of such access, such as for minors or spouses on a family plan.)

This section directs the Secretary of Health and Human Services, not later than one year after enactment of the PrEP Access and Coverage Act of 2026, to establish a grant program for states, territories, Indian tribes, and directly eligible entities (i.e., nonprofits providing PrEP and PEP information and services, including federally qualified health centers, family planning grantees, rural health clinics, Indian Health Service facilities, and community-based organizations) to support PrEP (pre-exposure prophylaxis for HIV prevention) and PEP (post-exposure prophylaxis) programs that increase access for uninsured and underinsured individuals and reduce disparities. Grantees must submit applications with detailed plans and appoint program administrators; awards consider service needs, numbers of uninsured and underinsured individuals, and coordination among applicants. Funds support eligible expenses, including FDA-approved HIV prevention drugs and related administrative fees, laboratory and monitoring services per U.S. Public Health Service guidelines, outreach and education to at-risk populations and providers, and adherence counseling with PrEP navigators. The Secretary must submit annual reports to Congress, and publish them on the HHS website, on program impacts for the first five years beginning one year after enactment. The section authorizes appropriations of such sums as necessary for FY2026 through FY2030.

This section establishes a private right of action allowing any person aggrieved by a violation of this Act to commence a civil action in an appropriate U.S. district court or other court of competent jurisdiction, either individually or as a class member, to obtain relief as allowed by law. The section requires courts to award costs and reasonable attorney fees to prevailing plaintiffs.

This section directs the Secretary of Health and Human Services (HHS), in consultation with the Centers for Disease Control and Prevention, to (1) issue guidance on implementing the HIV prevention coverage requirements (i.e., no cost-sharing for services such as pre-exposure prophylaxis under new sections 2799A–11 of the Public Health Service Act, 726 of ERISA, and 9826 of the Internal Revenue Code); (2) develop and disseminate educational materials, including billing and coding documents; (3) provide technical assistance to state insurance commissioners and eligible entities handling consumer complaints; and (4) coordinate with other federal agencies on enforcement. It further requires the Secretaries of HHS, Labor, and Treasury to monitor compliance by group health plans and health insurance issuers with such requirements and take enforcement actions; mandates annual submissions of compliance data—including aggregate claims data for HIV prevention services and enrollee cost-sharing—from plans and issuers for the 10-year period beginning on the date of enactment (with submissions beginning no later than one year after enactment); and requires joint biennial reports to Congress for a 10-year period (beginning no later than two years after enactment) assessing noncompliance prevalence, including aggregate information on noncompliant entities and enforcement steps taken.