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The bill expands no-cost access to FDA-approved HIV prevention drugs and related services for Medicare, Medicaid/CHIP, private plan enrollees, and federal employees—improving prevention access and lowering out-of-pocket costs—while increasing federal and private-sector spending and creating implementation and coverage-management burdens that could affect premiums, state budgets, and some patient drug choices.
Medicare beneficiaries (including low-income Part D enrollees), people with private group or individual plans, and federal employees will receive no-cost coverage for FDA-approved HIV prevention drugs, associated labs, counseling, and follow-up — eliminating deductibles and cost-sharing and substantially reducing out-of-pocket costs for those seeking PrEP/PEP.
Medicaid and CHIP enrollees — including children, pregnant women, and low-income adults — gain mandatory, no-cost coverage of HIV prevention services, increasing access to prevention for low-income and vulnerable populations.
Removing preauthorization requirements for covered HIV prevention drugs and related care will speed patient access and reduce delays in starting PrEP/PEP.
Taxpayers may face higher federal spending to cover expanded Medicare, Medicaid, CHIP, and FEHB costs for HIV prevention services, increasing federal outlays.
Private insurers will incur higher prescription drug and service costs, which could be passed on over time through higher premiums or altered plan designs, affecting middle-class families and small-business owners.
States may face administrative and budgetary burdens to update Medicaid/CHIP plans and, where required, enact state legislation to comply, straining state budgets and administrative capacity.
Introduced September 4, 2025 by Maxine Waters · Last progress September 4, 2025
Requires no-cost coverage of FDA-approved HIV prevention drugs (including PrEP and PEP) and related services — labs, counseling, administration fees, and clinical follow-up — across private group and individual plans, Medicare Parts B and D, Medicaid, CHIP, and the Federal Employees Health Benefits program. It also limits preauthorization requirements for these services, and phases in coverage and cost-sharing changes on specified effective dates for different programs.
