Sponsors (23)
Introduced March 4, 2026 by Tina Smith · Last progress March 4, 2026
The bill substantially expands and protects access to HIV prevention (PrEP/PEP) through no‑cost coverage, outreach, and enforcement—but does so at increased federal and private sector cost, with new administrative burdens, privacy tradeoffs, and greater litigation and implementation risk.
People at risk for HIV — including beneficiaries of Medicare, Medicaid, VA, TRICARE, FEHB, IHS, private plans, and uninsured programs — will get FDA‑approved PrEP/PEP medications, required labs, and monitoring with no cost‑sharing and fewer prior‑authorization barriers, improving access to prevention.
Communities disproportionately affected by HIV and health professionals — including communities of color, LGBTQ+ people, and clinicians — will receive culturally competent outreach, education, provider training, and navigation/adherence support, increasing awareness, reducing stigma, and expanding the number of providers who prescribe prevention medicines.
People on family plans and those taking PrEP will gain stronger privacy and nondiscrimination protections — dependents can obtain covered preventive services without disclosure on routine EOBs, and PrEP use cannot be used to deny or increase premiums for life/disability/long‑term care insurance.
Taxpayers and the federal budget will face higher costs because the bill expands coverage and authorizes programs (many provisions apply across Medicare, Medicaid, VA, TRICARE, FEHB, IHS and fund grant programs) and uses open‑ended 'such sums as necessary' authorities.
Private insurers, employers, and small businesses may face higher premiums and increased underwriting or administrative costs to absorb mandated coverage changes and limits on using PrEP as a risk factor, which could raise employer‑sponsored plan costs for workers.
State governments, providers, and insurers will incur new administrative and compliance burdens — reporting, billing/coding updates, provider training requirements, and Medicaid/CHIP statutory changes — that could delay implementation, complicate workflows, or create short‑term coverage gaps.
Based on analysis of 20 sections of legislative text.
Requires private health plans to cover FDA‑approved PrEP/PEP and related services without cost‑sharing or routine prior authorization, funds education/grants, strengthens enforcement, bans insurer discrimination, and creates a private right to sue.
Requires private group and individual health plans to cover FDA‑approved HIV prevention drugs (PrEP/PEP) and related services without cost‑sharing or routine prior authorization, expands privacy protections for individuals using those services on family plans, creates education campaigns and a grant program to expand access (especially for uninsured, underinsured, and disproportionately affected communities), strengthens federal monitoring and enforcement, bans insurance discrimination by life/disability/long‑term care insurers for people taking PrEP, and creates a private right of action for enforcement. The bill authorizes funding for education campaigns and grants for FY2026–FY2030 and directs multi‑year reporting and oversight requirements for plans and federal agencies.