119-hr5127

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5127 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 5127

 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.

_______________________________________________________________________

 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. Velazquez, 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. Barragan, 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.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``PrEP and PEP are Prevention Act''.

SEC. 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:

``

SEC. 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.
 <all>