I 
118TH CONGRESS 
1ST SESSION H. R. 4392 
To increase access to pre-exposure prophylaxis to reduce the transmission 
of HIV. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 27, 2023 
Mr. SCHIFF (for himself, Mr. BERA, Mr. BEYER, Mr. BOWMAN, Ms. BUSH, 
Mr. CARBAJAL, Mr. CARSON, Mr. CASTEN, Ms. CHU, Mr. COHEN, Mr. 
CONNOLLY, Ms. DAVIDS of Kansas, Ms. DEAN of Pennsylvania, Mr. 
DOGGETT, Mr. ESPAILLAT, Mr. EVANS, Ms. GARCIA of Texas, Mr. 
GARCI´A of Illinois, Mr. GOMEZ, Mr. GOTTHEIMER, Mr. GRIJALVA, Mr. 
HUFFMAN, Ms. JACOBS, Ms. JAYAPAL, Mr. JOHNSON of Georgia, Ms. 
LEE of California, Mr. LYNCH, Ms. MCCOLLUM, Mr. MCGOVERN, Ms. 
MOORE of Wisconsin, Mr. MOULTON, Mr. NEGUSE, Ms. NORTON, Mr. 
PANETTA, Mr. PASCRELL, Ms. PINGREE, Mr. POCAN, Ms. PORTER, Mr. 
QUIGLEY, Ms. SCANLON, Ms. SEWELL, Mr. STANTON, Ms. STEVENS, Ms. 
STRICKLAND, Mr. TAKANO, Ms. TITUS, Mr. TORRES of New York, Mrs. 
TORRES of California, Mr. TRONE, Ms. UNDERWOOD, Ms. VELA´ZQUEZ, 
Ms. WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, and Ms. WILD) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Oversight and 
Accountability, Ways and Means, Veterans’ Affairs, Armed Services, Nat-
ural Resources, Financial Services, and Education and the Workforce, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To increase access to pre-exposure prophylaxis to reduce 
the transmission of HIV. 
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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 and Cov-
erage Act of 2023’’. 
SEC. 2. FINDINGS; SENSE OF CONGRESS. 
(a) FINDINGS.—Congress finds the following: 
(1) The Centers for Disease Control and Pre-
vention estimates that approximately 1,200,000 indi-
viduals in the United States are living with HIV. 
(2) In 2021, there were 36,136 new diagnoses 
of HIV in the United States. 
(3) HIV disproportionately impacts gay and bi-
sexual men, transgender women, and, in particular, 
people of color. In 2021, approximately 71 percent 
of new HIV diagnoses were estimated to be among 
gay and bisexual men, 40 percent of new HIV diag-
noses were among Black people, and 29 percent of 
new HIV diagnoses were among Latinx people. Re-
cent studies suggest that transgender women are up 
to 49 times more likely to be diagnosed with HIV 
than the general population. Members of commu-
nities at the intersections of these groups are most 
heavily impacted. 
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(4) Pre-exposure prophylaxis (referred to in this 
section as ‘‘PrEP’’) is a daily antiretroviral medica-
tion that helps prevent individuals from acquiring 
HIV. Daily PrEP use reduces the risk of getting 
HIV from sex by more than 99 percent. It reduces 
the risk of getting HIV from injection drug use by 
at least 74 percent. 
(5) Many individuals at risk of exposure to HIV 
do not use PrEP. Of the approximately 1,200,000 
individuals in the United States who could benefit 
from PrEP, only 31 percent, or 382,364 individuals, 
filled prescriptions for the drug in 2022. 
(6) PrEP usage is inconsistent across racial 
and gender lines. In 2022, only 11 percent of Black/ 
African American and 21 percent of Hispanic/Latinx 
individuals who were eligible for PrEP were pre-
scribed it, compared to 82 percent of eligible White 
individuals. PrEP usage is low among women, in 
particular among heterosexual women of color, 
slightly less than 12 percent of women eligible for 
PrEP received a prescription in 2022. 
(7) PrEP use helps strengthen families by al-
lowing couples with partners of different HIV 
statuses to prevent the transmission of HIV. 
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(8) There are currently 2 brand name drugs 
and 1 generic drug approved by the Food and Drug 
Administration for the use of PrEP on a daily basis. 
A long-acting injectable PrEP drug has also been 
approved by the Food and Drug Administration. 
Other types of HIV prevention treatments, including 
other long-acting injectables, long-acting oral pills, 
implants, and vaginal rings are in the research pipe-
line. These innovations can increase widespread use 
of PrEP along with adherence, which can speed the 
Nation’s goal to end HIV and address inequities in 
health care. 
(9) Section 2713 of the Public Health Service 
Act (42 U.S.C. 300gg–13) requires non-grand-
fathered private health insurance plans to cover pre-
ventive services without cost-sharing, including such 
services with a rating of ‘‘A’’ or ‘‘B’’ under rec-
ommendations of the United States Preventive Serv-
ices Task Force. On June 11, 2019, the United 
States Preventive Services Task Force issued a final 
recommendation giving an ‘‘A’’ grade for PrEP for 
individuals at high risk of HIV; non-grandfathered 
private health insurance plans have to cover PrEP 
for such individuals without cost-sharing effective 
January 2021. Updated United States Preventive 
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Service Task Force guidance incorporating the new 
long-acting injectable PrEP drug is pending. 
(10) Joint guidance issued by the Department 
of Labor, the Department of Health and Human 
Services, and the Department of the Treasury on 
July 19, 2021, clarifies that ancillary services nec-
essary to maintain the PrEP regime, including sub-
sequent provider visits, clinical testing, and other 
services, is required to be covered by health insurers 
without cost-sharing. 
(11) Permanently expanding access to cost-free 
PrEP and ancillary services for all individuals, in-
cluding individuals who do not have health insur-
ance, through legislation, is a critical step towards 
eliminating HIV transmission. 
(12) Post-exposure prophylaxis (referred to in 
this section as ‘‘PEP’’) is a daily antiretroviral 
treatment which, when initiated promptly after a 
sexual or other exposure to blood or body fluids that 
are associated with a high risk of HIV transmission, 
is highly effective at preventing HIV transmission. 
(13) The Centers for Disease Control and Pre-
vention recommends PEP for an individual who has 
experienced a high-risk exposure incident, provided 
that the individual tests HIV-negative, initiates such 
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treatment not later than 72 hours after exposure, 
and continues the treatment for 28 days. 
(14) Despite PEP’s proven effectiveness in pre-
venting HIV transmission after high-risk sexual ex-
posures, including sexual assault, awareness of PEP 
is low among individuals who would benefit from the 
treatment. Studies suggest that awareness of PEP 
and of the importance of its prompt initiation is par-
ticularly low among young gay and bisexual men of 
color, transgender individuals, and women of all gen-
der identities. 
(15) Adequate knowledge of guidelines issued 
by the Centers for Disease Control and Prevention 
for assessing indications for PEP and for initiating 
and sustaining PEP are low among health care pro-
viders and staff. Because PEP is an emergency 
intervention, insufficient knowledge among providers 
and staff in hospital emergency rooms, urgent care 
centers, community health centers, and primary care 
physicians is of particular concern. 
(16) Private and public health insurance plans 
and programs frequently impose requirements for 
coverage of PEP, including pre-authorization re-
quirements and requirements to obtain the medica-
tions through designated specialty pharmacies and 
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mail-order programs that pose significant obstacles 
to timely initiation of treatment. 
(17) Insurance deductibles and co-payments for 
PEP medications create significant barriers to PEP 
utilization by many individuals who have experienced 
high-risk incidents. 
(18) The Federal Government has a compelling 
interest in preventing new cases of HIV. Lowering 
the prevalence of HIV protects public health and 
saves on the cost of HIV treatment. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that the Department of Labor, the Department of 
Health and Human Services, and the Department of the 
Treasury should ensure compliance with the requirements 
described in paragraphs (8) and (9) of subsection (a). 
SEC. 3. COVERAGE OF HIV TESTING AND PREVENTION 
SERVICES. 
(a) PRIVATE INSURANCE.— 
(1) IN GENERAL.—Section 2713(a) of the Pub-
lic Health Service Act (42 U.S.C. 300gg–13(a)) is 
amended— 
(A) in paragraph (2), by striking ‘‘; and’’ 
and inserting a semicolon; 
(B) in paragraph (3), by striking the pe-
riod and inserting a semicolon; 
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(C) in paragraph (4), by striking the pe-
riod and inserting a semicolon; 
(D) in paragraph (5), by striking the pe-
riod and inserting ‘‘; and’’; and 
(E) by adding at the end the following: 
‘‘(6) any prescription drug approved by the 
Food and Drug Administration for the prevention of 
HIV (other than a drug subject to preauthorization 
requirements consistent with section 2729A), admin-
istrative fees for such drugs, laboratory and other 
diagnostic procedures associated with the use of 
such drugs, and clinical follow-up and monitoring, 
including any related services recommended in cur-
rent United States Public Health Service clinical 
practice guidelines, without limitation.’’. 
(2) PROHIBITION ON PREAUTHORIZATION RE-
QUIREMENTS.—Subpart II of part A of title XXVII 
of the Public Health Service Act (42 U.S.C. 300gg– 
11 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 2729A. PROHIBITION ON PREAUTHORIZATION RE-
QUIREMENTS WITH RESPECT TO CERTAIN 
SERVICES. 
‘‘A group health plan or a health insurance issuer of-
fering group or individual health insurance coverage shall 
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not impose any preauthorization requirements with re-
spect to coverage of the services described in section 
2713(a)(6), except that a plan or issuer may impose 
preauthorization requirements with respect to coverage of 
a particular drug approved under section 505(c) of the 
Federal Food, Drug, and Cosmetic Act or section 351(a) 
of this Act if such plan or issuer provides coverage without 
any preauthorization requirements for a drug that is ther-
apeutically equivalent.’’. 
(b) 
COVERAGE
UNDER
FEDERAL
EMPLOYEES 
HEALTH BENEFITS PROGRAM.—Section 8904 of title 5, 
United States Code, is amended by adding at the end the 
following: 
‘‘(c) Any health benefits plan offered under this chap-
ter shall include benefits for, and may not impose any 
cost-sharing requirements for, any prescription drug ap-
proved by the Food and Drug Administration for the pre-
vention of HIV, administrative fees for such drugs, labora-
tory and other diagnostic procedures associated with the 
use of such drugs, and clinical follow-up and monitoring, 
including any related services recommended in current 
United States Public Health Service clinical practice 
guidelines, without limitation.’’. 
(c) MEDICAID.— 
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(1) IN GENERAL.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (a)(4)— 
(i) by striking ‘‘; and (D)’’ and insert-
ing ‘‘; (D)’’; 
(ii) by striking ‘‘; and (E)’’ and in-
serting ‘‘; (E)’’; 
(iii) by striking ‘‘; and (F)’’ and in-
serting ‘‘; (F)’’; and 
(iv) by striking the semicolon at the 
end and inserting ‘‘; and (G) HIV preven-
tion services;’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(jj) HIV PREVENTION SERVICES.—For purposes of 
subsection (a)(4)(G), the term ‘HIV prevention services’ 
means prescription drugs for the prevention of HIV acqui-
sition, administrative fees for such drugs, laboratory and 
other diagnostic procedures associated with the use of 
such drugs, and clinical follow-up and monitoring, includ-
ing any related services recommended in current United 
States Public Health Service clinical practice guidelines, 
without limitation.’’. 
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(2) NO COST-SHARING.—Title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.) is amend-
ed— 
(A) in section 1916, by inserting ‘‘HIV 
prevention 
services 
described 
in 
section 
1905(a)(4)(G),’’ after ‘‘section 1905(a)(4)(C),’’ 
each place it appears; and 
(B) in section 1916A(b)(3)(B), by adding 
at the end the following new clause: 
‘‘(xv) HIV prevention services de-
scribed in section 1905(a)(4)(G).’’. 
(3) INCLUSION
IN
BENCHMARK
COVERAGE.— 
Section 1937(b)(7) of the Social Security Act (42 
U.S.C. 1396u–7(b)(7)) is amended— 
(A) in the paragraph header, by inserting 
‘‘AND HIV PREVENTION SERVICES’’ after ‘‘SUP-
PLIES’’; and 
(B) by striking ‘‘includes for any individual 
described in section 1905(a)(4)(C), medical as-
sistance for family planning services and sup-
plies in accordance with such section’’ and in-
serting ‘‘includes medical assistance for HIV 
prevention 
services 
described 
in 
section 
1905(a)(4)(G), and includes, for any individual 
described in section 1905(a)(4)(C), medical as-
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sistance for family planning services and sup-
plies in accordance with such section’’. 
(d) CHIP.— 
(1) IN GENERAL.—Section 2103 of the Social 
Security Act (42 U.S.C. 1397cc), as amended by 
section 11405(b)(1) of Public Law 117–169, is 
amended— 
(A) in subsection (a), by striking ‘‘and 
(8)’’ and inserting ‘‘(8), (10), (11), and (13)’’; 
and 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(13) HIV PREVENTION
SERVICES.—Regard-
less of the type of coverage elected by a State under 
subsection (a), the child health assistance provided 
for a targeted low-income child, and, in the case of 
a State that elects to provide pregnancy-related as-
sistance pursuant to section 2112, the pregnancy-re-
lated assistance provided for a targeted low-income 
pregnant woman (as such terms are defined for pur-
poses of such section), shall include coverage of HIV 
prevention services (as defined in section 1905(jj)).’’. 
(2) NO COST-SHARING.—Section 2103(e)(2) of 
the Social Security Act (42 U.S.C. 1397cc(e)(2)) is 
amended by inserting ‘‘HIV prevention services de-
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scribed in subsection (c)(13),’’ before ‘‘or for preg-
nancy-related assistance’’. 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by subsection 
(c) and this subsection shall take effect on Jan-
uary 1, 2025. 
(B) DELAY PERMITTED IF STATE LEGISLA-
TION REQUIRED.—In the case of a State plan 
approved under title XIX or XXI of the Social 
Security Act which the Secretary of Health and 
Human Services determines requires State leg-
islation (other than legislation appropriating 
funds) in order for the plan to meet the addi-
tional requirements imposed by this section, the 
State plan shall not be regarded as failing to 
comply with the requirements of such title sole-
ly on the basis of the failure of the plan to meet 
such additional requirements before the 1st day 
of the 1st calendar quarter beginning after the 
close of the 1st regular session of the State leg-
islature that ends after the 1-year period begin-
ning with the date of the enactment of this sec-
tion. For purposes of the preceding sentence, in 
the case of a State that has a 2-year legislative 
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session, each year of the session is deemed to 
be a separate regular session of the State legis-
lature. 
(e) COVERAGE AND ELIMINATION OF COST-SHARING 
UNDER MEDICARE.— 
(1) COVERAGE OF HIV PREVENTION SERVICES 
UNDER PART B.— 
(A) COVERAGE.— 
(i) IN GENERAL.—Section 1861(s)(2) 
of the Social Security Act (42 U.S.C. 
1395x(s)(2)) is amended— 
(I) in subparagraph (II), by 
striking ‘‘and’’ at the end; 
(II) in subparagraph (JJ), by in-
serting ‘‘and’’ at the end; and 
(III) by adding at the end the 
following new subparagraph: 
‘‘(KK) HIV prevention services (as defined 
in subsection (nnn));’’. 
(ii) DEFINITION.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x) 
is amended by adding at the end the fol-
lowing new subsection: 
‘‘(nnn) HIV PREVENTION SERVICES.—The term 
‘HIV prevention services’ means— 
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‘‘(1) drugs or biologicals approved by the Food 
and Drug Administration for the prevention of HIV; 
‘‘(2) administrative fees for such drugs; 
‘‘(3) laboratory and other diagnostic procedures 
associated with the use of such drugs; and 
‘‘(4) clinical follow-up and monitoring, including 
any related services recommended in current United 
States Public Health Service clinical practice guide-
lines, without limitation.’’. 
(B) ELIMINATION OF COINSURANCE.—Sec-
tion 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended— 
(i) by striking ‘‘and (HH)’’ and in-
serting ‘‘(HH)’’; and 
(ii) by inserting before the semicolon 
at the end the following: ‘‘, and (II) with 
respect to HIV prevention services (as de-
fined in section 1861(nnn)), the amount 
paid shall be 100 percent of (i) except as 
provided in clause (ii), the lesser of the ac-
tual charge for the service or the amount 
determined under the fee schedule that ap-
plies to such services under this part, and 
(ii) in the case of such services that are 
covered OPD services (as defined in sub-
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section (t)(1)(B)), the amount determined 
under subsection (t)’’. 
(C) EXEMPTION FROM PART B DEDUCT-
IBLE.—The first sentence of section 1833(b) of 
the Social Security Act (42 U.S.C. 1395l(b)) is 
amended— 
(i) by striking ‘‘, and (13)’’ and in-
serting ‘‘(13)’’; and 
(ii) by striking ‘‘1861(n)..’’ and in-
serting ‘‘1861(n), and (14) such deductible 
shall not apply with respect to HIV pre-
vention services (as defined in section 
1861(nnn)(1)).’’. 
(D) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to items 
and services furnished on or after January 1, 
2025. 
(2) 
ELIMINATION
OF
COST-SHARING
FOR 
DRUGS FOR THE PREVENTION OF HIV UNDER PART 
D.— 
(A) IN
GENERAL.—Section 1860D–2 of 
the Social Security Act (42 U.S.C. 1395w– 
102(b)) is amended— 
(i) in subsection (b)— 
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(I) in paragraph (1)(A), by strik-
ing ‘‘and (9)’’ and inserting ‘‘, (9), 
and (10)’’; 
(II) in paragraph (2)— 
(aa) in subparagraph (A), 
by striking ‘‘and (9)’’ and insert-
ing ‘‘, (9), and (10)’’; 
(bb) in subparagraph (C)(i), 
in the matter preceding subclause 
(I), by striking ‘‘and (9)’’ and in-
serting ‘‘(9), and (10)’’; and 
(cc) in subparagraph (D)(i), 
in the matter preceding subclause 
(I), by striking ‘‘and (9)’’ and in-
serting ‘‘(9), and (10)’’; 
(III) in paragraph (3)(A), in the 
matter preceding clause (i), by strik-
ing ‘‘and (9)’’ and inserting ‘‘(9), and 
(10)’’; 
(IV) in paragraph (4)(A)(i), by 
striking ‘‘and (9)’’ and inserting ‘‘, 
(9), and (10)’’; and 
(V) by adding at the end the fol-
lowing new paragraph: 
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‘‘(10) ELIMINATION
OF
COST-SHARING
FOR 
DRUGS FOR THE PREVENTION OF HIV.—For plan 
years beginning on or after January 1, 2025, with 
respect to a covered part D drug that is for the pre-
vention of HIV— 
‘‘(A) the deductible under paragraph (1) 
shall not apply; and 
‘‘(B) there shall be no coinsurance or other 
cost-sharing under this part with respect to 
such drug.’’; and 
(ii) in subsection (c), by adding at the 
end the following new paragraph: 
‘‘(7) 
TREATMENT
OF
COST-SHARING
FOR 
DRUGS FOR THE PREVENTION OF HIV.—The cov-
erage is provided in accordance with subsection 
(b)(10).’’. 
(B) CONFORMING AMENDMENTS TO COST- 
SHARING FOR LOW-INCOME INDIVIDUALS.—Sec-
tion 1860D–14(a) of the Social Security Act 
(42 U.S.C. 1395w–114(a)) is amended— 
(i) in paragraph (1)(D), in each of 
clauses (ii) and (iii), by striking ‘‘para-
graph (6)’’ and inserting ‘‘paragraphs (6) 
and (7)’’; 
(ii) in paragraph (2)— 
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(I) in subparagraph (B), by 
striking ‘‘and (9)’’ and inserting ‘‘, 
(9), and (10)’’; 
(II) in subparagraph (D), by 
striking ‘‘paragraph (6)’’ and insert-
ing ‘‘paragraphs (6) and (7)’’; and 
(III) in subparagraph (E), by 
striking ‘‘paragraph (6)’’ and insert-
ing ‘‘paragraphs (6) and (7)’’; and 
(iii) by adding at the end the fol-
lowing new paragraph: 
‘‘(7) NO
APPLICATION
OF
COST-SHARING
OR 
DEDUCTIBLE FOR DRUGS FOR THE PREVENTION OF 
HIV.—For plan years beginning on or after January 
1, 2025, with respect to a covered part D drug that 
is for the prevention of HIV— 
‘‘(A) the deductible under section 1860D– 
2(b)(1) shall not apply; and 
‘‘(B) there shall be no cost-sharing under 
this section with respect to such drug.’’. 
(f) COVERAGE OF HIV PREVENTION TREATMENT BY 
DEPARTMENT OF VETERANS AFFAIRS.— 
(1) ELIMINATION
OF
MEDICATION
COPAY-
MENTS.—Section 1722A(a) of title 38, United 
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States Code, is amended by adding at the end the 
following new paragraph: 
‘‘(5) Paragraph (1) does not apply to a medication 
for the prevention of HIV.’’. 
(2) ELIMINATION OF HOSPITAL CARE AND MED-
ICAL SERVICES COPAYMENTS.—Section 1710 of such 
title is amended— 
(A) in subsection (f)— 
(i) by redesignating paragraph (5) as 
paragraph (6); and 
(ii) by inserting after paragraph (4) 
the following new paragraph (5): 
‘‘(5) A veteran shall not be liable to the United States 
under this subsection for any amounts for laboratory and 
other diagnostic procedures associated with the use of any 
prescription drug approved by the Food and Drug Admin-
istration for the prevention of HIV, administrative fees for 
such drugs, or for laboratory or other diagnostic proce-
dures associated with the use of such drugs, or clinical 
follow-up and monitoring, including any related services 
recommended in current United States Public Health 
Service clinical practice guidelines, without limitation.’’; 
and 
(B) in subsection (g)(3), by adding at the 
end the following new subparagraph: 
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‘‘(C) Any prescription drug approved by the 
Food and Drug Administration for the prevention of 
HIV, administrative fees for such drugs, laboratory 
and other diagnostic procedures associated with the 
use of such drugs, and clinical follow-up and moni-
toring, including any related services recommended 
in current United States Public Health Service clin-
ical practice guidelines, without limitation.’’. 
(3) INCLUSION AS PREVENTIVE HEALTH SERV-
ICE.—Section 1701(9) of such title is amended— 
(A) in subparagraph (K), by striking ‘‘; 
and’’ and inserting a semicolon; 
(B) by redesignating subparagraph (L) as 
subparagraph (M); and 
(C) by inserting after subparagraph (K) 
the following new subparagraph (L): 
‘‘(L) any prescription drug approved by 
the Food and Drug Administration for the pre-
vention of HIV, administrative fees for such 
drugs, laboratory and other diagnostic proce-
dures associated with the use of such drugs, 
and clinical follow-up and monitoring, including 
any related services recommended in current 
United States Public Health Service clinical 
practice guidelines, without limitation; and’’. 
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(g) COVERAGE OF HIV PREVENTION TREATMENT BY 
DEPARTMENT OF DEFENSE.— 
(1) IN
GENERAL.—Chapter 55 of title 10, 
United States Code, is amended by inserting after 
section 1074o the following new section: 
‘‘§ 1074p. Coverage of HIV prevention treatment 
‘‘(a) IN GENERAL.—The Secretary of Defense shall 
ensure coverage under the TRICARE program of HIV 
prevention treatment described in subsection (b) for any 
beneficiary under section 1074(a) of this title. 
‘‘(b) HIV PREVENTION TREATMENT DESCRIBED.— 
HIV prevention treatment described in this subsection in-
cludes any prescription drug approved by the Food and 
Drug Administration for the prevention of HIV, adminis-
trative fees for such drugs, laboratory and other diagnostic 
procedures associated with the use of such drugs, and clin-
ical follow-up and monitoring, including any related serv-
ices recommended in current United States Public Health 
Service clinical practice guidelines, without limitation. 
‘‘(c) NO COST-SHARING.—Notwithstanding section 
1075, 1075a, or 1074g(a)(6) of this title or any other pro-
vision of law, there is no cost-sharing requirement for HIV 
prevention treatment covered under this section.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
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by inserting after the item relating to section 1074o 
the following new item: 
‘‘1074p. Coverage of HIV prevention treatment.’’. 
(h) INDIAN
HEALTH
SERVICE
TESTING, MONI-
TORING, AND PRESCRIPTION DRUGS FOR THE PREVEN-
TION OF HIV.—Title II of the Indian Health Care Im-
provement Act is amended by inserting after section 223 
(25 U.S.C. 1621v) the following: 
‘‘SEC. 224. TESTING, MONITORING, AND PRESCRIPTION 
DRUGS FOR THE PREVENTION OF HIV. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of HIV/AIDS Prevention and Treatment 
under section 832, Indian tribes, and tribal organizations, 
shall provide, without limitation, funding for any prescrip-
tion drug approved by the Food and Drug Administration 
for the prevention of human immunodeficiency virus (com-
monly known as ‘HIV’), administrative fees for that drug, 
laboratory and other diagnostic procedures associated with 
the use of that drug, and clinical follow-up and moni-
toring, including any related services recommended in cur-
rent United States Public Health Service clinical practice 
guidelines. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as are nec-
essary to carry out this section.’’. 
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(i) EFFECTIVE DATE.—The amendments made by 
subsections (a), (b), (e), (f), (g), and (h) shall take effect 
with respect to plan years beginning on or after January 
1, 2025. 
SEC. 4. PROHIBITION ON DENIAL OF COVERAGE OR IN-
CREASE IN PREMIUMS OF LIFE, DISABILITY, 
OR LONG-TERM CARE INSURANCE FOR INDI-
VIDUALS TAKING MEDICATION FOR THE PRE-
VENTION OF HIV ACQUISITION. 
(a) PROHIBITION.—Notwithstanding any other provi-
sion of law, it shall be unlawful to— 
(1) decline or limit coverage of an individual 
under any life insurance policy, disability insurance 
policy, or long-term care insurance policy, on ac-
count of the individual taking medication for the 
purpose of preventing the acquisition of HIV; 
(2) preclude an individual from taking medica-
tion for the purpose of preventing the acquisition of 
HIV as a condition of receiving a life insurance pol-
icy, disability insurance policy, or long-term care in-
surance policy; 
(3) consider whether an individual is taking 
medication for the purpose of preventing the acquisi-
tion of HIV in determining the premium rate for 
coverage of such individual under a life insurance 
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policy, disability insurance policy, or long-term care 
insurance policy; or 
(4) otherwise discriminate in the offering, 
issuance, cancellation, amount of such coverage, 
price, or any other condition of a life insurance pol-
icy, disability insurance policy, or long-term care in-
surance policy for an individual, based solely and 
without any additional actuarial risks upon whether 
the individual is taking medication for the purpose 
of preventing the acquisition of HIV. 
(b) ENFORCEMENT.—A State insurance regulator 
may take such actions to enforce subsection (a) as are spe-
cifically authorized under the laws of such State. 
(c) DEFINITIONS.—In this section: 
(1) DISABILITY INSURANCE POLICY.—The term 
‘‘disability insurance policy’’ means a contract under 
which an entity promises to pay a person a sum of 
money in the event that an illness or injury resulting 
in a disability prevents such person from working. 
(2) LIFE INSURANCE POLICY.—The term ‘‘life 
insurance policy’’ means a contract under which an 
entity promises to pay a designated beneficiary a 
sum of money upon the death of the insured. 
(3) LONG-TERM
CARE
INSURANCE
POLICY.— 
The term ‘‘long-term care insurance policy’’ means 
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‘‘(1) submit an application to the Secretary at 
such time, in such manner, and containing such in-
formation as the Secretary may require, including a 
plan describing how any funds awarded will be used 
to increase access to PrEP for uninsured and under-
insured individuals and reduce disparities in access 
to PrEP and PEP for uninsured and underinsured 
individuals and reduce disparities in access to PrEP 
and PEP; and 
‘‘(2) appoint a PrEP and PEP grant adminis-
trator to manage the program. 
‘‘(c) DIRECTLY ELIGIBLE ENTITY.—For purposes of 
this section, the term ‘directly eligible entity’— 
‘‘(1) means a Federally qualified health center 
or other nonprofit entity engaged in providing PrEP 
and PEP information and services; and 
‘‘(2) may include— 
‘‘(A) a Federally qualified health center 
(as defined in section 1861(aa)(4) of the Social 
Security Act); 
‘‘(B) a family planning grantee (other than 
States) funded under section 1001; 
‘‘(C) a rural health clinic (as defined in 
section 1861(aa)(2) of the Social Security Act); 
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