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.