I 
119TH CONGRESS 
2D SESSION 
H. R. 7189 
To amend title XVIII of the Social Security Act to provide coverage for 
certain HIV prevention services furnished by pharmacists under the 
Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 21, 2026 
Mr. POCAN (for himself, Mrs. BEATTY, Ms. DEAN of Pennsylvania, Mr. GAR-
CIA of California, Ms. GARCIA of Texas, Mr. GOTTHEIMER, Ms. NORTON, 
Mr. JOHNSON of Georgia, Mrs. RAMIREZ, Ms. ROSS, Mr. TORRES of New 
York, and Mrs. WATSON COLEMAN) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committee on Ways and Means, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
coverage for certain HIV prevention services furnished 
by pharmacists under the Medicare program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘PrEP Access Act’’. 
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SEC. 2. COVERAGE OF PHARMACIST-PROVIDED HIV PRE-
VENTION SERVICES UNDER MEDICARE PART 
B. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (JJ), by inserting 
‘‘and’’ after the semicolon; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(KK) pharmacist-provided HIV prevention 
services (as defined in subsection (nnn));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(nnn) PHARMACIST-PROVIDED HIV PREVENTION 
SERVICES.—The term ‘pharmacist-provided HIV preven-
tion services’ means such services furnished by a phar-
macist, and such services and supplies furnished as inci-
dent to the pharmacist’s service, as would otherwise be 
covered if furnished by a physician or as an incident to 
a physicians’ service that— 
‘‘(1) the pharmacist is legally authorized to fur-
nish under State law; and 
‘‘(2) are services related to the prevention of 
human immunodeficiency virus, including evaluation, 
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management, screening, consultation, and counseling 
services related to— 
‘‘(A) pre-exposure prophylaxis, post-expo-
sure prophylaxis, or other evidence-based inter-
ventions for the prevention of human immuno-
deficiency virus; 
‘‘(B) medication administration for such 
interventions; or 
‘‘(C) clinical diagnostic laboratory tests re-
lated to such interventions.’’. 
(b) PAYMENT.—Section 1833(a)(1) of the Social Se-
curity Act (42 U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and (HH)’’ and inserting 
‘‘(HH)’’; and 
(2) by inserting before the semicolon at the end 
‘‘, and (II) with respect to pharmacist-provided HIV 
prevention 
services 
(as 
defined 
in 
section 
1861(nnn)), the amounts paid shall be equal to 80 
percent of the lesser of (i) the actual charge for the 
services or (ii) 85 percent of the amount determined 
under the payment basis under section 1848 for 
such services’’. 
(c) PROHIBITION ON BALANCE BILLING FOR PHAR-
MACIST SERVICES.—Section 1842(b)(18) of the Social Se-
curity Act (42 U.S.C. 1395u(b)(18)) is amended— 
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(1) in subparagraph (A), by inserting ‘‘or a 
pharmacist’’ after ‘‘a practitioner described in sub-
paragraph (C)’’; 
(2) in subparagraph (B)— 
(A) by inserting ‘‘, pharmacist,’’ after ‘‘a 
practitioner described in subparagraph (C)’’; 
and 
(B) in the third sentence— 
(i) by inserting ‘‘, pharmacist,’’ after 
‘‘a practitioner’’; and 
(ii) by inserting ‘‘, pharmacist,’’ after 
‘‘the practitioner’’; and 
(3) in subparagraph (D), by inserting ‘‘or a 
pharmacist’’ after ‘‘a practitioner described in sub-
paragraph (C)’’. 
(d) CONFORMING AMENDMENT.—Section 1862(a)(1) 
of the Social Security Act (42 U.S.C. 1395y(a)(1)) is 
amended— 
(1) in subparagraph (O), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (P), by striking the semi-
colon at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
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‘‘(Q) in the case of pharmacist-provided HIV 
prevention 
services 
(as 
defined 
in 
section 
1861(nnn)), which are not reasonable and necessary 
for the prevention or detection of human immuno-
deficiency virus;’’. 
(e) APPLICATION.—The amendments made by this 
section shall apply to items and services furnished on or 
after January 1, 2027. 
Æ 
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