Sponsors (35)
The bill greatly expands no‑cost access to FDA‑approved HIV prevention across Medicaid, Medicare, and private plans—improving prevention and lowering out‑of‑pocket costs—but does so at the expense of higher federal/state/private spending and increased administrative and oversight burdens.
Medicaid and CHIP beneficiaries (low-income people) will receive FDA-approved HIV prevention services as a mandatory, no-cost benefit, improving access for millions with low incomes.
Medicare beneficiaries will face little or no out-of-pocket cost for HIV prevention—no Part B coinsurance/deductible and no Part D deductible or cost-sharing for covered prevention drugs—reducing financial barriers for seniors and people with disabilities.
People with private group and individual health plans will gain comprehensive coverage (no limits) for FDA-approved HIV prevention drugs and related services (labs, counseling, follow-up), lowering financial and administrative barriers to prevention.
Taxpayers will likely face higher federal spending because Medicare, Medicaid, and federal employee plans cover HIV prevention with no cost-sharing, increasing the federal budgetary burden.
Private insurance enrollees may experience higher premiums over time as insurers absorb increased drug and service expenditures for no‑cost HIV prevention benefits.
State governments will incur administrative, regulatory, and possibly legislative costs to update Medicaid/CHIP programs to comply, straining state budgets and agencies.
Based on analysis of 2 sections of legislative text.
Requires private plans and Medicare Part B to cover FDA-approved HIV prevention drugs (PrEP/PEP) and related services, removes Part B cost-sharing and limits prior authorization.
Introduced September 4, 2025 by Maxine Waters · Last progress September 4, 2025
Requires private group and individual health plans and Medicare Part B to cover FDA-approved drugs and related services for HIV prevention (including PrEP and PEP) without patient cost-sharing and with limits on prior authorization. Coverage must include drugs/biologics, administrative fees, required lab and diagnostic tests, counseling (risk assessment, risk reduction, adherence), and clinical follow-up/monitoring recommended in current U.S. Public Health Service clinical practice guidelines. Private-plan changes begin the first plan year after enactment; Medicare parts eliminate Part B coinsurance and the Part B deductible for these HIV prevention services.