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Requires federal and private health plans to cover FDA-approved HIV prevention drugs (PrEP/PEP) and related clinical services without cost-sharing or prior authorization in most cases, starting January 1, 2027. Creates education campaigns, a grant program to expand access (prioritizing uninsured and underserved communities), protects patient confidentiality for use of preventive services on family plans, forbids life/disability/long-term care insurers from discriminating based on preventive HIV medication use, and allows people harmed by violations to sue and recover fees.
The bill substantially expands and clarifies no‑cost access, outreach, privacy, and enforcement for HIV prevention—improving prevention access and consumer protections—while imposing material federal and private‑sector costs, administrative burdens, uneven state rollout risks, and greater litigation
People with private insurance, Medicare, Medicaid, VA/TRICARE, FEHB, and IHS coverage will get FDA‑approved HIV prevention drugs, related lab tests, and follow-up care without copays, deductibles, or coinsurance and generally without prior authorization, increasing affordable access to prevention.
HHS guidance, standardized billing/coding materials, mandatory insurer reporting, and interagency coordination will improve enforcement, reduce improper denials, and make plan compliance more transparent.
People using PrEP/PEP cannot be denied life, disability, or long‑term care insurance, forced off medication to obtain coverage, or have premiums raised solely because they take HIV‑prevention drugs, protecting consumers from specific forms of insurance discrimination.
Targeted public education and culturally competent provider training (with multi‑year funding authorization) will increase awareness of PrEP/PEP, reduce stigma, and encourage more local clinicians to offer prevention services in high‑need communities.
Expanding no‑cost coverage across Medicare, Medicaid, VA/DoD/FEHB and funding outreach/grants will increase federal and program spending and could raise taxes or divert federal resources.
Insurers, employers, and plan administrators face new reporting, billing, confidentiality, and compliance costs that may be passed to consumers through higher premiums or employer contributions.
Fee‑shifting and a private right of action increase litigation risk and legal costs for businesses and other defendants and could lead to more claims (including weak or nuisance suits) and higher prices or administrative burden.
Implementation and enforcement may be uneven across states—some states may need enabling legislation for Medicaid/CHIP changes and enforcement of anti‑discrimination protections may vary—producing unequal access depending on where people live.
Require the Secretary of Health and Human Services, in consultation with the CDC, to issue guidance on implementing the coverage requirements established by this Act and its amendments.
Require the Secretary of Health and Human Services to develop and disseminate educational materials, including billing and coding documents based on stakeholder consensus, as appropriate.
Require the Secretary of Health and Human Services to provide technical assistance to State insurance commissioners.
Require the Secretary of Health and Human Services to provide technical assistance to eligible entities for responding to and resolving consumer complaints.
Require the Secretary of Health and Human Services to work with other Federal agencies to assist in enforcement and compliance.
Individuals at risk of HIV will see lower financial and administrative barriers to prevention drugs and related care because most plans must cover PrEP/PEP without cost-sharing or prior authorization. Uninsured and underinsured people may gain access through the new grant program, while community groups and state/Tribal programs can receive federal grants to provide outreach, clinical care, and adherence support. Health care providers will be targeted by an education campaign to increase appropriate prescribing and reduce stigma. Private insurers must change plan design and claims processes to comply; life, disability, and long-term care insurers cannot use preventive medication use to deny coverage or raise premiums. HHS, Labor, and Treasury will take on monitoring, data collection, technical guidance, and enforcement roles; state insurance regulators enforce anti-discrimination rules for certain insurers. The law authorizes funding for education and grants through FY2026–2030 but does not itself appropriate funds, so actual program scale depends on future appropriations. The HIPAA change strengthens confidentiality for enrollees using preventive services on family plans. The private right of action increases enforcement options for individuals and may spur compliance through litigation risk.
Adds a new section 399V–9 to Part P of title III of the Public Health Service Act establishing a PrEP and PEP grant program, including definitions, application requirements, allowable uses of funds, reporting, and an authorization of appropriations for FY2026–2030.
Directs the Secretary of Health and Human Services to amend HHS regulations promulgated under section 264(c) of HIPAA to ensure individuals can access certain preventive benefits under a family plan without informing other enrollees.
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Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Introduced March 4, 2026 by Tina Smith · Last progress March 4, 2026
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Introduced in Senate