An Act to Clarify and
Maine Legislature, Session 132, LD 1687
Committee Amendment CA_A_H642 (House)
Amends: 22 MRSA §3197, 24-A MRSA §4317-D, 32 MRSA §13786-E

COMMITTEE AMENDMENT" f\"toH.P. 1122, L.D. 1687, "An Act to Clarify and 
Increase Access to HIV Prevention Medications" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 22 MRSA §3197 is enacted to read: 
§3197. Prescribing, dispensing and administering HIV prevention drugs 
1. Definition. As used in this section, unless the context othe1wise indicates, "HIV 
prevention drug" has the same meaning as in Title 32, section 13786-E, subsection 1, 
paragraph B. 
2. Reimbursement for pharmacists prescribing, dispensing and administering 
HIV prevention drugs. No later than January 1, 2027, the department shall provide 
reimbursement under the MaineCare program to a pharmacist for prescribing, dispensing 
and administering HIV prevention drugs under Title 32, section 13786-E. The department: 
A. 
Shall provide coverage for services provided by the pharmacist under this 
subsection; 
B. Shall authorize a phannacist to bill the carrier and receive direct payment for a 
service under this subsection that the pharmacist provides to a MaineCare member and 
shall identify the pharmacist as the provider in the billing and the claims process for 
payment of the service: and 
C. May not impose on a pharmacist a practice, education or collaboration requirement 
that is inconsistent with or more restrictive than a requirement of state law or an agency 
0 
or board rule for the pharmacist to receive payment for a service provided under this 
subsection. 
3, Reimbursement model. No later than January 1, 2027, the department shall create 
and implement under the MaineCare program a reimbursement model to increase access to 
HIV prevention drugs administered under Title 32, section 13786-E. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A" to H.P. 1122, L.D. 1687 
Sec. 2. 24-A MRSA §4317-D, sub-§2, as enacted by PL 2021, c. 265, §4, is 
amended to read: 
2. Coverage required. A carrier offering a health plan in this State shall provide 
coverage for an HIV prevention drug that has been prescribed by a provider or that has 
been prescribed, dispensed and administered by a pharmacist under Title 32, section 
13786-E. Coverage under this section is subject to the following. 
A. If the federal Food and Drug Administration has approved one or more HIV 
prevention drugs that use the same method of administration, a carrier is not required 
to cover all approved drugs as long as the carrier covers at least one approved drug for 
each method of administration with no out-of-pocket cost. Notwithstanding this 
paragraph, a carrier shall provide coverage with no out-of-pocket cost for HIV 
prevention drugs for the prevention of the acquisition of HIV infection in accordance 
with a rating of A or B in the recommendations of the United States Preventive Services 
Task Force or equivalent rating from a successor organization and guidelines issued by 
the United States Department of Health and Human Services, Centers for Medicare and 
Medicaid Services. 
B. A carrier is not required to cover any preexposure prophylaxis drug or post-
exposure prophylaxis drug dispensed or administered by an out-of-network pharmacy 
provider unless the enrollee's health plan provides an out-of-network pharmacy benefit. 
C. A carrier may not prohibit, or permit a pharmacy benefits manager to prohibit, a 
pharmacy provider from prescribing, dispensing or administering any HIV prevention 
drugs. 
D. A carrier shall authorize a pharmacist to bill the carrier and receive direct payment 
for a service that the pharmacist provides to an enrollee pursuant to this section and 
shall identify the pharmacist as the provider in the billing and claims process for 
payment for the service. A carrier may not impose on a pharmacist, in order for the 
pharmacist to receive payment for a service provided pursuant to this section, a 
practice, education or collaboration requirement that is inconsistent with or more 
restrictive than a requirement of state law or agency or board rules. 
Sec. 3. 24-A MRSA §4317-D, sub-§3, as enacted by PL 2021, c. 265, §4, is 
amended to read: 
3. Limits on prior authorization and step therapy requirements. Notwithstanding 
any requirements in section 4304 or 4320-N to the contrary, a carrier may not subject any 
HIV prevention drug to any prior authorization or step therapy requirement except as 
provided in this subsection. If the federal Food and Drug Administration has approved one 
or more methods of administering HIV prevention drugs, a carrier is not required to cover 
all of the approved drugs without prior authorization or step therapy requirements as long 
as the carrier covers at least one approved drug for each method of administration without 
prior authorization or step therapy requirements. Notwithstanding this subsection, a carrier 
shall provide coverage without prior authorization or step therapy requirements for HIV 
prevention drugs for the prevention of the acquisition of HIV infection in accordance with 
a rating of A or B in the recommendations of the United States Preventive Services Task 
Force or equivalent rating from a successor organization and guidelines issued by the 
United States Department of Health and Human Services, Centers for Medicare and 
Medicaid Services. If prior authorization or step therapy requirements are met for a 
COMMITTEE AMENDMENT 
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COJvfMJ.TfEE AMEND1IBNT ''A' to H.P. 1122, L.D. 1687 
particular enrollee with regard to a particular HIV prevention chug, the can-ier is required 
to cover that drug with no out-of-pocket cost to the enrollee. 
Sec. 4. 32 MRSA §13786-E, sub-§2, ~' as enacted by PL 2021, c. 265, §6, is 
amended to read: 
B. A pharmacist shall dispense or administer a preexposure prophylaxis drug in at least 
a 30-day supply, and up to a 60-day supply of an oral medication, or in one 
administration of an injectable medication of any duration, as long as all of the 
following conditions are met: 
(1) The patient tests negative for HIV infection, as documented by a negative HIV 
test result obtained within the previous 7 days. If the patient does not provide 
evidence of a negative HIV test result in accordance with this subparagraph, the 
pharmacist shall order an HIV test. If the test results are not transmitted directly 
to the pharmacist, the pha1macist shall verify the test results to the pharmacist's 
satisfaction. If the patient tests positive for HIV infection, the pharmacist or person 
administering the test shall direct the patient to a primary care provider and provide 
a list of prima1y care providers and clinics within a reasonable travel distance of 
the patient's residence; 
(2) The patient does not report any signs or symptoms of acute HIV infection on 
a self-reporting checklist of acute HIV infection signs and symptoms; 
(3) The patient does not report taking any contraindicated medications; 
(4) The pharmacist provides counseling to the patient, consistent with CDC 
guidelines, on the ongoing use of a preexposure prophylaxis drug. The pharmacist 
shall notify the patient that the patient must be seen by a primary care provider to 
receive subsequent prescriptions for a preexposure prophylaxis drug and that a 
pharmacist may not dispense or administer more than a 60-day supply of a an oral 
preexposure prophylaxis drug or one administration of an injectable preexposure 
prophylaxis drug of any duration to a single patient once every 2 years without a 
prescription; 
(5) The pharmacist documents, to the extent possible, the services provided by the 
pharmacist in the patient's record in the patient profile record system maintained 
by the pharmacy. 
The pharmacist shall maintain records of preexposure 
prophylaxis drugs dispensed or administered to each patient; 
(6) The pharmacist does not dispense or administer more than a 60-day supply of 
a an oral preexposure prophylaxis drug or one administration of an injectable 
preexposure prophylaxis drug of any duration to a single patient once every 2 years, 
unless otherwise directed by a practitioner; and 
(7) The pharmacist notifies the patient's primary care provider that the pharmacist 
completed the requirements specified in this paragraph. If the patient does not have 
a primary care provider, or refuses consent to notify the patient's primaiy care 
provider,. the pharmacist shall provide the patient a list of physicians, clinics or 
other health care providers to contact regarding follow-up care. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A' to H.P. 1122, L.D. 1687 
Sec. 5. Exemption from review. Notwithstanding the Maine Revised Statutes, 
Title 24-A, section 2752, this Act is enacted without review and evaluation by the 
Department of Professional and Financial Regulation, Bureau of Insurance. 
Sec. 6. Department of Health and Human Services to apply for waiver 
under Medicaid program. The Department of Health and Human Services shall apply 
to the United States Department of Health and Human Services, Centers for Medicare and 
Medicaid Services for any amendment to the state Medicaid plan or for any waiver under 
the state Medicaid program necessary to implement this Act by January 1, 2027. 
Sec. 7. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care - Payments to Providers 0147 
Initiative: Provides funding for MaineCare reimbursement to pharmacists for HIV 
prevention medications. 
GENERAL FUND 
2025-26 
2026-27 
All Other 
$0 
$1,470 
GENERAL FUND TOTAL 
$0 
$1,470 
FEDERAL EXPENDITURES FUND 
2025-26 
2026-27 
All Other 
$0 
$15,591 
FEDERAL EXPENDITURES FUND TOTAL 
$0 
$15,591 
OTHER SPECIAL REVENUE FUNDS 
2025-26 
2026-27 
All Other 
$0 
$1,609 
OTHER SPECIAL REVENUE FUNDS TOTAL 
$0 
$1,609 
Office of MaineCare Services 0129 
Initiative: Provides one-time funding for technology costs to implement MaineCare 
reimbursement to pharmacists for HIV prevention medications. 
GENERAL FUND 
2025-26 
2026-27 
All Other 
$0 
$42,794 
GENERAL FUND TOTAL 
$0 
$42,794 
FEDERAL EXPENDITURES FUND 
2025-26 
2026-27 
All Other 
$0 
$131,360 
FEDERAL EXPENDITURES FUND TOTAL 
$0 
$131,360 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A' to H.P. 1122, L.D, 1687 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
2025-26 
$0 
$0 
$0 
$0 
2026-27 
$44,264 
$146,951 
$1,609 
$192,824 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment removes the language in the bill requiring pharmacists to be 
reimbursed at the same reimbursement rates as physicians for the dispensing or 
administering of HIV prevention medications. The amendment retains the clarification in 
the bill that health insurance carriers are required to provide coverage for HIV prevention 
medications, including injectable preexposure prophylaxis drugs of any duration. The 
amendment reallocates the provision requiring health insurance carriers to provide 
coverage for the services provided by pharmacists to the Maine Insurance Code and makes 
other clarifying changes to the bill. The amendment also adds an appropriations and 
allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/06/25 LRL 
LD 1687 
LR2100(02) 
An Act to Clarify and Increase Access to HIV Prevention Medications 
Fiscal Note for Bill as Amended_ by Committee Amendment 'A' (H-~4'2J 
Committee: Health Coverage, Insurance and Financial Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Federal Expenditures Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY2025-26 
$0 
$0 
$0 
$0 
$0 
$0 
FY2026-27 
$44,264 
$44,264 
$146,951 
$1,609 
$146,951 
$1,609 
Projections 
FY2027-28 
$2,939 
$2,939 
$31,183 
$3,218 
$31,183 
$3,218 
Projections 
FY 2028-29 
$2,939 
$2,939 
$31,183 
$3,218 
$31,183 
$3,218 
The bill includes ongoing General Fund appropriations to the Department of Health and Human Services of $1,474 in 
fiscal year 2026-27 to provide reimbursement to pharmacists under the MaineCare program beginning January 1, 2027 
for prescribing, dispensing and administering HN prevention medications in an amount not to exceed a 60-day supply 
to an individual once every two years. The bill also includes a one-time General Fund appropriation to the department 
of $42,974 in fiscal year 2026-27 for technology costs to implement the MaineCare reimbursement to pharmacists. 
Federal Expenditure Funds allocations are also included for matching funds and Other Special Revenue Funds 
allocations are included for drug rebates. . 
Any additional costs to the Department of Professional and Financial Regulation, Maine Board of Pharmacy to 
implement the provisions of this bill are expected to be minor and can be absorbed within existing budgeted resources. 
LR2100(02) - Fiscal Note - Page 1 of 1