I 
116TH CONGRESS 
1ST SESSION H. R. 3815 
To increase access to pre-exposure prophylaxis to reduce the transmission 
of HIV. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 17, 2019 
Mr. SCHIFF (for himself, Mrs. WATSON COLEMAN, Ms. LEE of California, Mr. 
KHANNA, Ms. MUCARSEL-POWELL, Mr. RUSH, Mr. CRIST, Ms. 
BARRAGA´N, Ms. HAALAND, Mr. PAPPAS, Mr. MOULTON, Mr. COX of 
California, Mr. COHEN, and Ms. PRESSLEY) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Oversight and Reform, Veterans’ Affairs, 
Ways and Means, Natural Resources, Armed Services, and Financial 
Services, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To increase access to pre-exposure prophylaxis to reduce 
the transmission of HIV. 
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’’. 
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SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) The Centers for Disease Control and Pre-
vention estimates that approximately 1,100,000 peo-
ple in the United States are living with HIV. 
(2) In 2017, there were 38,281 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. For example, in 2017 approximately 
66 percent of new HIV diagnoses were among gay 
and bisexual men, 43 percent of new HIV diagnoses 
were among Black people, and 26 percent of new 
HIV diagnoses were among Latinx people. Recent 
studies suggest that transgender women are up to 
49 times more likely to be diagnosed with HIV than 
the general population. Members of communities at 
the intersections of these groups are most heavily 
impacted. 
(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 over 90 percent. It reduces the risk 
of getting HIV from injection drug use by over 70 
percent. 
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(5) Many individuals at risk of exposure to HIV 
do not use PrEP. Of the approximately 1,100,000 
people in the United States who could benefit from 
PrEP, only 7 percent, or 78,360 individuals, filled 
prescriptions for the drug in 2016. 
(6) PrEP usage is inconsistent across racial 
and gender lines. In 2016, PrEP users were 68.7 
percent White, 11.2 percent Black, and 13.1 percent 
Latinx. However, individuals eligible for PrEP were 
26.3 percent White, 43.7 percent Black, and 24.7 
percent Latinx. Additionally, only 2.1 percent of 
women eligible for PrEP received a prescription in 
2016. 
(7) There is currently only one version of PrEP 
approved by the Food and Drug Administration, 
marketed under the brand name of Truvada, which, 
in 2018, had a list price of over $20,000 a year in 
the United States. A less expensive, generic version 
of PrEP is expected to be available in September 
2020, and other types of HIV prevention treat-
ments, including oral pills, vaginal rings, and long- 
acting injectables, are currently in the research pipe-
line. 
(8) Section 2713 of the Public Health Service 
Act (42 U.S.C. 300gg–13) requires most private 
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health insurance plans to cover preventive services 
without cost sharing, including such services with a 
rating of ‘‘A’’ or ‘‘B’’ under recommendations of the 
United States Preventive Services Task Force. On 
June 11, 2019, the United States Preventive Serv-
ices Task Force issued a final recommendation giv-
ing an ‘‘A’’ grade for PrEP for individuals at high 
risk of HIV; non-grandfathered private health insur-
ance plans will have to cover PrEP for such individ-
uals without cost sharing by 2021. 
(9) Despite such recommendation of the United 
States Preventive Services Task Force, access bar-
riers to PrEP remain. Ancillary services necessary to 
maintain the PrEP regime, including subsequent 
provider visits, clinical testing, and other services, 
can remain a cost-burden on patients. Additionally, 
the new recommendations are not linked to coverage 
requirements for individuals with other types of in-
surance, such as Medicare or Medicaid. 
(10) Expanding access to cost-free PrEP and 
ancillary services for all individuals, including indi-
viduals who do not have health insurance, is a crit-
ical step towards eliminating HIV transmission. 
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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; 
(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 acquisition, laboratory 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 guide-
lines, 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– 
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11 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 2729. 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 
not impose any pre-authorization requirements with re-
spect to coverage of the services described in section 
2713(a)(6).’’. 
(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 approved 
by the Food and Drug Administration for the prevention 
of HIV acquisition, 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.’’. 
(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)’’; and 
(ii) by inserting ‘‘; and (E) HIV pre-
vention services’’ before the semicolon; and 
(B) by adding at the end the following new 
subsection: 
‘‘(ff) HIV PREVENTION SERVICES.—For purposes of 
subsection (a)(4)(E), the term ‘HIV prevention services’ 
means prescription drugs for the prevention of HIV acqui-
sition, laboratory and other diagnostic procedures associ-
ated with the use of such drugs, and clinical follow up 
and monitoring, including any related services rec-
ommended in current United States Public Health Service 
clinical practice guidelines, without limitation.’’. 
(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)(E),’’ after ‘‘section 1905(a)(4)(C),’’ 
each place it appears; and 
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(B) in section 1916A(b)(3)(B), by adding 
at the end the following new clause: 
‘‘(xi) HIV prevention services de-
scribed in section 1905(a)(4)(E).’’. 
(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 inserting ‘‘, and, for any individual 
described in section 1905(a)(4)(E), medical as-
sistance for HIV prevention services in accord-
ance with such section’’ before the period. 
(d) CHIP.— 
(1) IN GENERAL.—Section 2103(c) of the So-
cial Security Act (42 U.S.C. 1397cc(c)), as amended 
by section 5022 of the SUPPORT for Patients and 
Communities Act (Public Law 115–271), is amended 
by adding at the end the following new paragraph: 
‘‘(10) HIV PREVENTION SERVICES.—The child 
health assistance provided to a targeted low-income 
child and the pregnancy-related assistance provided 
to a targeted low-income woman shall include cov-
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erage of HIV prevention services (as defined in sec-
tion 1905(ff)).’’. 
(2) NO COST SHARING.—Section 2103(e)(2) of 
the Social Security Act (42 U.S.C. 1397cc(e)(2)) is 
amended by inserting ‘‘, for HIV prevention services 
described in subsection (c)(10),’’ after ‘‘subsection 
(c)(1)(D)’’. 
(3) 
CONFORMING
AMENDMENT.—Section 
2103(a) of the Social Security Act (42 U.S.C. 
1397cc(a)), as amended by section 5022 of the 
SUPPORT for Patients and Communities Act (Pub-
lic Law 115–271), is amended in the matter pre-
ceding paragraph (1) by striking ‘‘and (8)’’ and in-
serting ‘‘(8), and (10)’’. 
(4) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (A), the amendments made by subsection 
(c) and this subsection shall take effect on Jan-
uary 1, 2021. 
(B) DELAY PERMITTED IF STATE LEGISLA-
TION REQUIRED.—In the case of a State plan 
approved under title XIX of the Social Security 
Act which the Secretary of Health and Human 
Services determines requires State legislation 
(other than legislation appropriating funds) in 
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order for the plan to meet the additional re-
quirements imposed by this section, the State 
plan shall not be regarded as failing to comply 
with the requirements of such title solely on the 
basis of the failure of the plan to meet such ad-
ditional requirements before the 1st day of the 
1st calendar quarter beginning after the close 
of the 1st regular session of the State legisla-
ture that ends after the 1-year period beginning 
with the date of the enactment of this section. 
For purposes of the preceding sentence, in the 
case of a State that has a 2-year legislative ses-
sion, each year of the session is deemed to be 
a separate regular session of the State legisla-
ture. 
(e) WAIVER OF COST SHARING UNDER MEDICARE.— 
(1) PART B.— 
(A) INCLUSION AS A PREVENTIVE SERV-
ICE.—Section 1861(ddd)(3) of the Social Secu-
rity Act (42 U.S.C. 1395x(ddd)(3)) is amended 
by adding at the end the following new sub-
paragraph: 
‘‘(D) Drugs or biologicals approved by the 
Food and Drug Administration for the preven-
tion of HIV acquisition, laboratory and other 
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(1) IN
GENERAL.—Chapter 55 of title 10, 
United States Code, is amended by inserting after 
section 1079c the following new section: 
‘‘§ 1079d. 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 acquisi-
tion, laboratory and other diagnostic procedures associ-
ated with the use of such drugs, and clinical follow up 
and monitoring, including any related services rec-
ommended 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 
by inserting after the item relating to section 1079c 
the following new item: 
‘‘1079d. Coverage of HIV prevention treatment.’’. 
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