PrEP and PEP are Prevention Act

This bill would make HIV prevention services free for people with most types of health coverage. Plans would have to cover medicines that prevent HIV, like PrEP and PEP, plus the lab tests, counseling, and follow-up visits that go with them—without copays or deductibles. This applies to private insurance, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and federal employee health plans . Private plans could not require prior approval for these services, unless they still offer at least one equivalent drug without prior approval.

• Who is affected: People with private insurance, people on Medicare (Parts B and D), Medicaid and CHIP enrollees, and federal employees and retirees under FEHB .
• What changes: No cost-sharing for HIV prevention drugs and related care. Medicare Part B covers services with no coinsurance and no deductible; Part D waives the deductible and all cost-sharing for HIV prevention drugs. Medicaid and CHIP must cover these services with no cost-sharing. FEHB plans must include these benefits at no cost to patients .
• When: Private insurance and Medicare Part D changes start with the first plan year after the bill becomes law. Medicare Part B coverage starts January 1 of the first calendar year after. Medicaid/CHIP changes start January 1 of the first calendar year after, with extra time allowed if a state needs to pass a law. FEHB changes start the first plan year after the bill becomes law .