“A bill to increase access to pre-exposure prophylaxis to reduce the transmission of HIV.”
No CRS summary available for this bill.
This section expresses the sense of Congress that the Department of Labor, Department of Health and Human Services, and Department of the Treasury should ensure compliance with the requirements of this Act.
This section requires nongrandfathered group health plans and health insurance issuers to cover, without cost-sharing, prescription drugs approved by the FDA for HIV prevention (except those subject to preauthorization consistent with PHSA §2729A-11), related administrative fees, laboratory and diagnostic procedures, and clinical follow-up and monitoring per U.S. Public Health Service guidelines—including deeming current USPSTF breast cancer screening recommendations the most current other than those issued around November 2009. It applies this requirement to grandfathered plans; prohibits preauthorization for these services across PHSA Part D, ERISA plans, and IRC group health plans (except if a therapeutically equivalent drug is covered without preauthorization); requires the same coverage without cost-sharing in Federal Employees Health Benefits plans; and mandates coverage of these "HIV prevention services" in Medicaid.
This section prohibits life, disability, and long-term care insurers from denying or limiting coverage, precluding use of HIV prevention medication as a policy condition, increasing premiums, or otherwise discriminating against individuals based solely on their use of such medication (without additional actuarial risks). It authorizes state insurance regulators to enforce the prohibition under state law and defines the covered insurance policy types.
This section establishes public and provider education campaigns on pre-exposure prophylaxis (PrEP, i.e., FDA-approved drugs for preventing HIV before exposure) and post-exposure prophylaxis (PEP, i.e., FDA-approved drugs for preventing HIV after high-risk exposure), to be conducted by the HHS Secretary through the Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), and Office of Infectious Disease and HIV/AIDS Policy. The public campaign, developed with input from organizations indigenous to high-need communities (i.e., communities of color and LGBTQ+ overrepresented in the U.S. HIV epidemic), must increase awareness of PrEP and PEP safety and effectiveness, recommended clinical practices, local provider availability, and counter related stigma, with evaluation measures for reducing access disparities via community outreach, language services, and workforce cultural competence. The provider campaign, developed with input from affected-community providers and organizations, must increase prescriber readiness and cultural competency in high-need areas, with evaluation measures for expanding PrEP and PEP services 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 regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (HIPAA privacy rule) as necessary to ensure that individuals may access benefits required under section 2713(a)(5) of the Public Health Service Act (i.e., Health Resources and Services Administration-recommended women's preventive services, including contraceptives) through a family health plan without other enrollees—including the primary subscriber or policyholder—being informed of such use. (Thus, the change protects the privacy of protected health information related to these services within family plans.)
This section establishes a grant program, to be implemented by the HHS Secretary not later than one year after enactment, under which 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) may receive funds to increase access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention among uninsured and underinsured individuals and to reduce related disparities. Grantees must submit applications with detailed plans and appoint a program administrator; awards are based on need, uninsured/underinsured populations, and coordination; and funds may be used for approved HIV prevention drugs and related services per U.S. Public Health Service guidelines, outreach and education, provider training, and adherence support including PrEP navigators. The HHS Secretary must submit annual reports to Congress on program impacts for five years beginning one year after enactment (publicly available on the HHS website), with authorization 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—including amendments made by 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 Act's coverage requirements for HIV prevention services (i.e., no-cost-sharing coverage under group health plans and health insurance); (2) develop and disseminate educational materials, including stakeholder-consensus billing and coding documents; (3) provide technical assistance to state insurance commissioners; (4) assist eligible entities in handling consumer complaints; and (5) coordinate with other federal agencies on enforcement. This section further requires the Secretaries of HHS, Labor, and Treasury, in consultation with the CDC Director, to (1) monitor compliance by group health plans and health insurance issuers with the Act's HIV prevention coverage requirements and take enforcement actions; (2) require annual data submissions from such plans and issuers, beginning one year after enactment and continuing for 10 years, demonstrating compliance including aggregate data on HIV prevention services claims received and enrollee cost-sharing; and (3) submit joint reports to Congress and publicly, beginning two years after enactment and biennially thereafter for 10 years, assessing noncompliance prevalence, identifying noncompliant entities in aggregate, and detailing enforcement steps taken.