PrEP and PEP are Prevention Act

Bill: 119-hr-5127
Sponsor: full_name: Rep. Waters, Maxine [D-CA-43]
Introduced: 2025-09-04
Policy area: Health
Latest action: action_date: 2025-09-04
text: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, 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 committee concerned.

Summaries:

tv_txt: I 119th CONGRESS 1st Session H. R. 5127 IN THE HOUSE OF REPRESENTATIVES September 4, 2025 Ms. Waters (for herself, Mr. Garcia of California , Mr. Nadler , Ms. Norton , Mr. Thompson of Mississippi , Mr. Krishnamoorthi , Ms. Garcia of Texas , Ms. Velázquez , Ms. Sewell , Mr. Carson , Mr. Jackson of Illinois , Ms. Titus , Mr. Johnson of Georgia , Mrs. McIver , Mrs. Beatty , Mr. Cleaver , Mr. Cohen , Ms. Wilson of Florida , Ms. Simon , Mr. Thanedar , Mr. Mullin , Mrs. Ramirez , Ms. Barragán , Mrs. Watson Coleman , Ms. Tlaib , Ms. Clarke of New York , and Ms. Williams of Georgia ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committees on Ways and Means , and Oversight and Government Reform , 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 committee concerned A BILL To amend title XXVII of the Public Health Service Act, titles XVIII, XIX, and XXI of the Social Security Act, and title 5, United States Code, to require no-cost coverage of certain HIV prevention services.

1. Short title This Act may be cited as the PrEP and PEP are Prevention Act . 2. No-cost coverage of HIV prevention services (a) Private insurance (1) In general Section 2713(a) of the Public 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 period and inserting a semicolon; (C) in paragraph (4), by striking the period and inserting a semicolon; (D) in paragraph (5), by striking the period 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), including any such drug approved for use as pre-exposure prophylaxis (commonly referred to as PrEP ) or as post-exposure prophylaxis (commonly referred to as PEP ), administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, counseling with respect to HIV prevention (including HIV risk assessment, HIV risk reduction, and medication adherence), and clinical follow up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation. . (2) Prohibition on preauthorization requirements 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 following: 2729A. Prohibition on preauthorization requirements with respect to certain services A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not impose any preauthorization requirements with respect 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 therapeutically equivalent. . (3) Effective date The amendments made by this subsection shall apply beginning with respect to the first plan year beginning after the date of enactment of this section. (b) 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 (JJ), by inserting and at the end; and (II) 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 following new subsection: (nnn) HIV prevention services The term HIV prevention services means— (1) drugs or biologicals approved by the Food and Drug Administration for the prevention of HIV, including any such drug or biological approved for use as pre-exposure prophylaxis (commonly referred to as PrEP ) or as post-exposure prophylaxis (commonly referred to as PEP ); (2) administrative fees for such drugs and biologicals; (3) laboratory and other diagnostic procedures associated with the use of such drugs and biologicals; (4) counseling with respect to HIV prevention, including HIV risk assessment, HIV risk reduction, and medication adherence; and (5) clinical follow up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation. . (B) Elimination of coinsurance Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— (i) by striking and (HH) and inserting (HH) ; and (ii) by inserting before the semicolon at the end the following: , and (II) with respect to HIV prevention services (as defined in section 1861(nnn)), the amount paid shall be 100 percent of (i) except as provided in clause (ii), the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to such services under this part, and (ii) in the case of such services that are covered OPD services (as defined in subsection (t)(1)(B)), the amount determined under subsection (t) . (C) Exemption from Part B deductible 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 inserting (13) ; and (ii) by striking 1861(n).. and inserting 1861(n), and (14) such deductible shall not apply with respect to HIV prevention 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 of the first calendar year beginning after the date of enactment of this section. (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)— (I) in paragraph (1)(A), by striking and (9) and inserting , (9), and (10) ; (II) in paragraph (2)— (aa) in subparagraph (A), by striking and (9) and inserting , (9), and (10) ; (bb) in subparagraph (C)(i), in the matter preceding subclause (I), by striking and (9) and inserting (9), and (10) ; and (cc) in subparagraph (D)(i), in the matter preceding subclause (I), by striking and (9) and inserting (9), and (10) ; (III) in paragraph (3)(A), in the matter preceding clause (i), by striking 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 following new paragraph: (10) Elimination of cost-sharing for drugs for the prevention of HIV With respect to a covered part D drug that is for the prevention 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 coverage is provided in accordance with subsection (b)(10). . (B) Conforming amendments to cost-sharing for low-income individuals Section 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 paragraph (6) and inserting paragraphs (6) and (7) ; (ii) in paragraph (2)— (I) in subparagraph (B), by striking and (9) and inserting , (9), and (10) ; (II) in subparagraph (D), by striking paragraph (6) and inserting paragraphs (6) and (7) ; and (III) in subparagraph (E), by striking paragraph (6) and inserting paragraphs (6) and (7) ; and (iii) by adding at the end the following new paragraph: (7) No application of cost-sharing or deductible for drugs for the prevention of HIV 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. . (C) Effective date The amendments made by this paragraph shall apply beginning with respect to the first plan year beginning after the date of enactment of this section. (c) Medicaid and CHIP (1) Medicaid (A) In general Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended— (i) in subsection (a)(4)— (I) by striking ; and (D) and inserting ; (D) ; (II) by striking ; and (E) and inserting ; (E) ; (III) by striking ; and (F) and inserting ; (F) ; and (IV) by striking the semicolon at the end and inserting ; and (G) HIV prevention services; ; and (ii) by adding at the end the following new subsection: (ll) HIV prevention services For purposes of subsection (a)(4)(G), the term HIV prevention services means prescription drugs approved by the Food and Drug Administration for the prevention of HIV, including any such drug approved for use as pre-exposure prophylaxis (commonly referred to as PrEP ) or as post-exposure prophylaxis (commonly referred to as PEP ), administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, counseling with respect to HIV prevention (including HIV risk assessment, HIV risk reduction, and medication adherence), and clinical follow up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation. . (B) No cost-sharing Title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) is amended— (i) 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 (ii) in section 1916A(b)(3)(B), by adding at the end the following new clause: (xv) HIV prevention services described in section 1905(a)(4)(G). . (C) Inclusion in benchmark coverage Section 1937(b)(7) of the Social Security Act ( 42 U.S.C. 1396u–7(b)(7) ) is amended— (i) in the paragraph header, by inserting and HIV prevention services after supplies ; and (ii) by striking includes for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section and inserting 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 assistance for family planning services and supplies in accordance with such section . (2) CHIP (A) 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— (i) in subsection (a), by striking and (8) and inserting (8), and (13) ; and (ii) in subsection (c), by adding at the end the following new paragraph: (13) HIV prevention services Regardless 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 assistance pursuant to section 2112, the pregnancy-related assistance provided for a targeted low-income pregnant woman (as such terms are defined for purposes of such section), shall include coverage of HIV prevention services (as defined in section 1905(ll)). . (B) 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 described in subsection (c)(13), before or for pregnancy-related assistance . (3) Effective date (A) In general Subject to subparagraph (B), the amendments made by this subsection shall take effect on January 1 of the first calendar year beginning after the date of enactment of this section. (B) Delay permitted if State legislation 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 legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements 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 additional requirements before the 1st day of the 1st calendar quarter beginning after the close of the 1st regular session of the State legislature 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 session, each year of the session is deemed to be a separate regular session of the State legislature. (d) Federal Employees Health Benefits program (1) In general 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 chapter 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, including any such drug approved for use as pre-exposure prophylaxis (commonly referred to as PrEP ) or as post-exposure prophylaxis (commonly referred to as PEP ), administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, counseling with respect to HIV prevention (including HIV risk assessment, HIV risk reduction, and medication adherence), and clinical follow up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation. . (2) Effective date The amendments made by this subsection shall apply beginning with respect to the first plan year beginning after the date of enactment of this section.