[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7853 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 7853
To increase access to pre-exposure prophylaxis to reduce the
transmission of HIV.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 5, 2026
Mr. Takano (for himself, Mr. Pocan, and Ms. Balint) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Oversight and Government
Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural
Resources, Financial Services, and Education and Workforce, 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 increase access to pre-exposure prophylaxis to reduce the
transmission of HIV.
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 Access and Coverage Act of
2026''.
SEC. 2. SENSE OF CONGRESS.
It is the sense of Congress that the Department of Labor, the
Department of Health and Human Services, and the Department of the
Treasury should ensure compliance with the requirements described in
this Act.
SEC. 3. COVERAGE REQUIREMENTS.
(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 ``; and'';
(D) by striking paragraph (5);
(E) by adding at the end the following:
``(5) any prescription drug approved by the Food and Drug
Administration used for the prevention of HIV (other than a
drug subject to preauthorization requirements consistent with
section 2729A-11), administrative fees for such drugs,
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 guidelines,
including policy notes updating those guidelines, without
limitation.''; and
(F) by adding at the end of the flush text at the
end the following: ``For the purposes of this Act, and
for the purposes of any other provision of law, the
current recommendations of the United States Preventive
Service Task Force regarding breast cancer screening,
mammography, and prevention shall be considered the
most current other than those issued in or around
November 2009.''.
(2) Grandfathered plans.--Section 1251(a)(4) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18011(a)(4)) is
amended by adding at the end the following:
``(v) Section 2713(a)(5) (relating to
coverage without cost-sharing for prescription
drugs for the prevention of HIV).''.
(3) Prohibition on preauthorization requirements.--
(A) PHSA.--Part D of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg-111 et seq.) is
amended by adding at the end the following:
``SEC. 2799A-12. 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)(5), 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.''.
(B) ERISA.--
(i) In general.--Subpart B of part 7 of
subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at
the end the following:
``SEC. 727. PROHIBITION ON PREAUTHORIZATION REQUIREMENTS WITH RESPECT
TO CERTAIN SERVICES.
``A group health plan or a health insurance issuer offering group
health insurance coverage shall not impose any preauthorization
requirements with respect to coverage of the services described in
section 2713(a)(5) of the Public Health Service Act, 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 the Public
Health Service Act if such plan or issuer provides coverage without any
preauthorization requirements for a drug that is therapeutically
equivalent.''.
(ii) Clerical amendment.--The table of
contents in section 1 of the Employee
Retirement Income Security Act of 1974 (29
U.S.C. 1001 et seq.) is amended by inserting
after the item relating to section 726 the
following new item:
``Sec. 727. Prohibition on preauthorization requirements with respect
to certain services.''.
(C) IRC.--
(i) In general.--Chapter 100 of the
Internal Revenue Code of 1986 is amended by
adding at the end of subchapter B the
following:
``SEC. 9827. PROHIBITION ON PREAUTHORIZATION REQUIREMENTS WITH RESPECT
TO CERTAIN SERVICES.
``A group health plan shall not impose any preauthorization
requirements with respect to coverage of the services described in
section 2713(a)(5) of the Public Health Service Act, except that a plan
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 the Public Health Service
Act if such plan provides coverage without any preauthorization
requirements for a drug that is therapeutically equivalent.''.
(ii) Clerical amendment.--The table of
sections for subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by
adding at the end the following new item:
``Sec. 9827. Prohibition on preauthorization requirements with respect
to certain services.''.
(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 chapter shall
include benefits for, and may not impose any cost-sharing requirements
for any prescription drug approved by the Food and Drug Administration
used for the prevention of HIV, administrative fees for such drugs,
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 guidelines, including policy notes updating
those guidelines, without limitation.''.
(c) Medicaid.--
(1) In general.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended by--
(A) in subsection (a)(4), by striking the semicolon
at the end and inserting ``; and (G) HIV prevention
services;''; and
(B) 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 all prescription
drugs used for the prevention of HIV acquisition, administrative fees
for such drugs, 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 guidelines, including policy
notes updating those guidelines without limitation.''.
(2) No cost-sharing.--Title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) is amended--
(A) 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
(B) 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).''.
(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 heading, by inserting ``and
hiv prevention services'' after ``supplies''; and
(B) 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''.
(d) CHIP.--
(1) In general.--Section 2103 of the Social Security Act
(42 U.S.C. 1397cc) is amended--
(A) in subsection (a), in the matter preceding
paragraph (1), by striking ``and (8)'' and inserting
``(8), and (13)''; and
(B) 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)).''.
(2) No cost-sharing.--Section 2103(e)(2) of the Social
Security Act (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the paragraph heading, by inserting ``HIV
prevention services,'' after ``treatment,''; and
(B) 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 subsection (c) and this subsection
shall take effect on January 1, 2027.
(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 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.
(e) Coverage and Elimination of Cost-Sharing Under 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
striking ``and'' at the end;
(II) in subparagraph (KK), by
inserting ``and'' at the end; and
(III) by adding at the end the
following new subparagraph:
``(LL) HIV prevention services (as defined in
subsection (ooo));''.
(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:
``(ooo) 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;
``(2) administrative fees for such drugs;
``(3) laboratory and other diagnostic procedures associated
with the use of such drugs; and
``(4) clinical follow-up and monitoring, including any
related services recommended in current United States Public
Health Service clinical practice guidelines, including policy
notes updating those 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(ooo)), 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(ooo)(1)).''.
(D) Effective date.--The amendments made by this
paragraph shall apply to items and services furnished
on or after January 1, 2027.
(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) 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.--For plan years beginning on or after
January 1, 2027, 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.--For plan years beginning on
or after January 1, 2027, 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.''.
(f) Coverage of HIV Prevention Treatment by Department of Veterans
Affairs.--
(1) Elimination of medication copayments.--Section 1722A(a)
of title 38, United States Code, is amended by adding at the
end the following new paragraph:
``(5) Paragraph (1) does not apply to a medication for the
prevention of HIV.''.
(2) Elimination of hospital care and medical services
copayments.--Section 1710 of such title is amended--
(A) in subsection (f)--
(i) by redesignating paragraph (5) as
paragraph (6); and
(ii) by inserting after paragraph (4) the
following new paragraph (5):
``(5) A veteran shall not be liable to the United States under this
subsection for any amounts for laboratory and other diagnostic
procedures associated with the use of any prescription drug approved by
the Food and Drug Administration and used for the prevention of HIV,
administrative fees for such a drug, or clinical follow-up and
monitoring, including any related services recommended in current
United States Public Health Service clinical practice guidelines,
including policy notes updating those guidelines, without
limitation.''; and
(B) in subsection (g)(3), by adding at the end the
following new subparagraph:
``(C) Any prescription drug approved by the Food and Drug
Administration and used for the prevention of HIV,
administrative fees for such a drug, laboratory and other
diagnostic procedures associated with the use of such a drug,
and clinical follow-up and monitoring, including any related
services recommended in current United States Public Health
Service clinical practice guidelines, including policy notes
updating those guidelines, without limitation.''.
(3) Inclusion as preventive health service.--Section
1701(9) of such title is amended--
(A) in subparagraph (K), by striking ``; and'' and
inserting a semicolon;
(B) by redesignating subparagraph (L) as
subparagraph (M); and
(C) by inserting after subparagraph (K) the
following new subparagraph (L):
``(L) any prescription drug approved by the Food
and Drug Administration and used for the prevention of
HIV, administrative fees for such a drug, laboratory
and other diagnostic procedures associated with the use
of such a drug, and clinical follow-up and monitoring,
including any related services recommended in current
United States Public Health Service clinical practice
guidelines, including policy notes updating those
guidelines, without limitation; and''.
(g) Coverage of HIV Prevention Treatment by Department of
Defense.--
(1) In general.--Chapter 55 of title 10, United States
Code, is amended by inserting after section 1074o the following
new section:
``Sec. 1074p. 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 includes any prescription drug approved by
the Food and Drug Administration and used for the prevention of HIV,
administrative fees for such a drug, laboratory and other diagnostic
procedures associated with the use of such a drug, and clinical follow-
up and monitoring, including any related services recommended in
current United States Public Health Service clinical practice
guidelines, including policy notes updating those guidelines, without
limitation.
``(c) No Cost-Sharing.--Notwithstanding section 1075, 1075a, or
1074g(a)(6) of this title or any other provision of law, there is no
cost-sharing requirement for HIV prevention treatment covered under
this section.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1074o the following new item:
``1074p. Coverage of HIV prevention treatment.''.
(h) Indian Health Service Testing, Monitoring, and Prescription
Drugs for the Prevention of HIV.--Title II of the Indian Health Care
Improvement Act is amended by inserting after section 223 (25 U.S.C.
1621v) the following:
``SEC. 224. TESTING, MONITORING, AND PRESCRIPTION DRUGS FOR THE
PREVENTION OF HIV.
``(a) In General.--The Secretary, acting through the Director of
HIV/AIDS Prevention and Treatment under section 832, shall provide,
without limitation, funding for any prescription drug approved by the
Food and Drug Administration for the prevention of human
immunodeficiency virus (commonly known as `HIV'), administrative fees
for that drug, laboratory and other diagnostic procedures associated
with the use of that drug, and clinical follow-up and monitoring,
including any related services recommended in current Public Health
Service clinical practice guidelines, including policy notes updating
those guidelines.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section.''.
(i) Effective Date.--The amendments made by subsections (a), (b),
(e), (f), (g), and (h) shall take effect with respect to plan years
beginning on or after January 1, 2027.
SEC. 4. PROHIBITION ON DENIAL OF COVERAGE OR INCREASE IN PREMIUMS OF
LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE FOR
INDIVIDUALS TAKING MEDICATION FOR THE PREVENTION OF HIV
ACQUISITION.
(a) Prohibition.--Notwithstanding any other provision of law, it
shall be unlawful to--
(1) decline or limit coverage of an individual under any
life insurance policy, disability insurance policy, or long-
term care insurance policy, on account of the individual taking
medication for the purpose of preventing the acquisition of
HIV;
(2) preclude an individual from taking medication for the
purpose of preventing the acquisition of HIV as a condition of
receiving a life insurance policy, disability insurance policy,
or long-term care insurance policy;
(3) consider whether an individual is taking medication for
the purpose of preventing the acquisition of HIV in determining
the premium rate for coverage of such individual under a life
insurance policy, disability insurance policy, or long-term
care insurance policy; or
(4) otherwise discriminate in the offering, issuance,
cancellation, amount of such coverage, price, or any other
condition of a life insurance policy, disability insurance
policy, or long-term care insurance policy for an individual,
based solely and without any additional actuarial risks upon
whether the individual is taking medication for the purpose of
preventing the acquisition of HIV.
(b) Enforcement.--A State insurance regulator may take such actions
to enforce subsection (a) as are specifically authorized under the laws
of such State.
(c) Definitions.--In this section:
(1) Disability insurance policy.--The term ``disability
insurance policy'' means a contract under which an entity
promises to pay a person a sum of money in the event that an
illness or injury resulting in a disability prevents such
person from working.
(2) Life insurance policy.--The term ``life insurance
policy'' means a contract under which an entity promises to pay
a designated beneficiary a sum of money upon the death of the
insured.
(3) Long-term care insurance policy.--The term ``long-term
care insurance policy'' means a contract for which the only
insurance protection provided under the contract is coverage of
qualified long-term care services (as defined in section
7702B(c) of the Internal Revenue Code of 1986).
SEC. 5. PUBLIC EDUCATION CAMPAIGN.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-8. PRE-EXPOSURE PROPHYLAXIS AND POST-EXPOSURE PROPHYLAXIS
EDUCATION CAMPAIGNS.
``(a) Public Education Campaign.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, in
consultation with the Director of the Office of Infectious
Disease and HIV/AIDS Policy, shall establish a public health
campaign for the purpose of educating the public on medication
for the prevention of HIV acquisition.
``(2) Requirements.--In carrying out this subsection, the
Secretary shall ensure cultural competency and efficacy within
high-need communities in which PrEP or PEP are underutilized by
developing the campaign in collaboration with organizations
that are indigenous to communities that are overrepresented in
the domestic HIV epidemic, including communities of color and
the lesbian, gay, bisexual, transgender, and queer community.
The Secretary shall ensure that the campaign is designed to
increase awareness of the safety and effectiveness of PrEP and
PEP, the recommended clinical practices for providing PrEP-
related and PEP-related clinical care, and the local
availability of PrEP and PEP providers, and to counter stigma
associated with the use of PrEP and PEP.
``(3) Evaluation of program.--The Secretary shall develop
measures to evaluate the effectiveness of activities conducted
under this subsection that are aimed at reducing disparities in
access to PrEP and PEP and supporting the local community. Such
measures shall evaluate community outreach activities, language
services, workforce cultural competence, and other areas as
determined by the Secretary.
``(b) Provider Education Campaign.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, the
Administrator of the Health Resources and Services
Administration, and the Office of Infectious Disease and HIV/
AIDS Policy, shall establish a provider campaign for the
purpose of educating prescribers and other associated health
professionals on medication for the prevention of HIV
acquisition.
``(2) Requirements.--In carrying out this subsection, the
Secretary shall increase awareness and readiness among health
care providers to offer PrEP or PEP, as appropriate, with a
focus on areas of high-need communities in which PrEP or PEP is
underutilized by developing an educational campaign with input
from health care providers and organizations from communities
that are disproportionately affected by the domestic HIV
epidemic, including communities of color and the lesbian, gay,
bisexual, transgender, and queer community. The Secretary shall
ensure that the campaign is designed to increase awareness of
the safety and effectiveness of PrEP and PEP, the recommended
clinical practices for providing PrEP-related and PEP-related
clinical care, cultural competency among PrEP and PEP
prescribers, and to counter stigma associated with the use of
PrEP and PEP.
``(3) Evaluation of program.--The Secretary shall develop
measures to evaluate the effectiveness of activities conducted
under this subsection that are aimed at increasing the number
of health care professionals offering PrEP and PEP and reducing
disparities in access to PrEP and PEP. Such measures shall
evaluate availability of PrEP and PEP services, education and
outreach activities, language services, workforce cultural
competence, and other areas as determined by the Secretary.
``(c) Definitions.--In this section and section 399V-9--
``(1) the term `PEP' means any drug or combination of drugs
approved by the Food and Drug Administration for preventing HIV
transmission after a sexual or other exposure associated with a
high risk of HIV transmission; and
``(2) the term `PrEP' means any drug approved by the Food
and Drug Administration for the purpose of pre-exposure
prophylaxis with respect to HIV.
``(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2026 through 2030.''.
SEC. 6. PATIENT CONFIDENTIALITY.
The Secretary of Health and Human Services shall amend the
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note), as
necessary, to ensure that individuals are able to access the benefits
described in section 2713(a)(5) under a family plan without any other
individual enrolled in such family plan, including a primary subscriber
of or policyholder, being informed of such use of such benefits.
SEC. 7. PREP AND PEP FUNDING.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.), as amended by section 5, is further amended by adding at
the end the following:
``SEC. 399V-9. PRE-EXPOSURE PROPHYLAXIS AND POST-EXPOSURE PROPHYLAXIS
FUNDING.
``(a) In General.--Not later than 1 year after the date of
enactment of the PrEP Access and Coverage Act of 2026, the Secretary
shall establish a program that awards grants to States, territories,
Indian Tribes, and directly eligible entities for the establishment and
support of pre-exposure prophylaxis (referred to in this section as
`PrEP') and post-exposure prophylaxis (referred to in this section as
`PEP') programs.
``(b) Applications.--To be eligible to receive a grant under
subsection (a), a State, territory, Indian Tribe, or directly eligible
entity shall--
``(1) submit an application to the Secretary at such time,
in such manner, and containing such information as the
Secretary may require, including a plan describing how any
funds awarded will be used to increase access to PrEP for
uninsured and underinsured individuals and reduce disparities
in access to PrEP and PEP for uninsured and underinsured
individuals and reduce disparities in access to PrEP and PEP;
and
``(2) appoint a PrEP and PEP grant administrator to manage
the program.
``(c) Directly Eligible Entity.--For purposes of this section, the
term `directly eligible entity'--
``(1) means a nonprofit entity engaged in providing PrEP
and PEP information and services; and
``(2) may include--
``(A) a Federally qualified health center (as
defined in section 1861(aa)(4) of the Social Security
Act);
``(B) a family planning grantee (other than States)
funded under section 1001;
``(C) a rural health clinic (as defined in section
1861(aa)(2) of the Social Security Act);
``(D) a health facility operated by or pursuant to
a contract with the Indian Health Service;
``(E) a community-based organization, clinic,
hospital, or other health facility that provides
services to individuals at risk for or living with HIV;
and
``(F) a nonprofit private entity providing
comprehensive primary care to populations at risk of
HIV, including faith-based and community-based
organizations.
``(d) Awards.--In determining whether to award a grant, and the
grant amount for each grant awarded, the Secretary shall consider the
grant application and the need for PrEP and PEP services in the area,
the number of uninsured and underinsured individuals in the area, and
how the State, territory, or Indian Tribe coordinates PrEP and PEP
activities with the directly funded entity, if the State, territory, or
Indian Tribe applies for the funds.
``(e) Use of Funds.--
``(1) In general.--Any State, territory, Indian Tribe, or
directly eligible entity that is awarded funds under subsection
(a) shall use such funds for eligible PrEP and PEP expenses.
``(2) Eligible prep expenses.--The Secretary shall publish
a list of expenses that qualify as eligible PrEP and PEP
expenses for purposes of this section, which shall include--
``(A) any prescription drug approved by the Food
and Drug Administration used for the prevention of HIV,
administrative fees for such drugs, 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
guidelines, including policy notes updating those
guidelines, without limitation;
``(B) outreach and public education activities
directed toward populations overrepresented in the
domestic HIV epidemic that increase awareness about the
existence of PrEP and PEP, provide education about
access to and health care coverage of PrEP and PEP,
PrEP and PEP adherence programs, and counter stigma
associated with the use of PrEP and PEP;
``(C) outreach activities directed toward
physicians and other providers that provide education
about PrEP and PEP; and
``(D) adherence services and counseling, including
personnel costs for PrEP navigators to retain patients
in care.
``(f) Report to Congress.--The Secretary shall, in each of the
first 5 years beginning 1 year after the date of enactment of the PrEP
Access and Coverage Act of 2026, submit to Congress, and make public on
the website of Department of Health and Human Services, a report on the
impact of any grants provided to States, territories, Indian Tribes,
and directly eligible entities for the establishment and support of
pre-exposure prophylaxis programs under this section.
``(g) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2026 through 2030.''.
SEC. 8. CLARIFICATION.
This Act, including the amendments made by this Act, shall apply
notwithstanding any other provision of law, including Public Law 103-
141.
SEC. 9. PRIVATE RIGHT OF ACTION.
Any person aggrieved by a violation of this Act, including the
amendments made by this Act, may commence a civil action in an
appropriate United States District Court or other court of competent
jurisdiction to obtain relief as allowed by law as either an individual
or member of a class. If the plaintiff is the prevailing party in such
an action, the court shall order the defendant to pay the costs and
reasonable attorney fees of the plaintiff.
SEC. 10. ENFORCEMENT.
(a) In General.--The Secretary of Health and Human Services, in
consultation with the Centers for Disease Control and Prevention,
shall--
(1) issue guidance regarding the implementation of the
coverage requirements established under this Act, including the
amendments made by this Act, including with respect to
implementation of such coverage requirements;
(2) develop and disseminate educational materials,
including billing and coding documents based on stakeholder
consensus-driven recommendations, as appropriate;
(3) provide technical assistance to State insurance
commissioners;
(4) provide technical assistance to eligible entities
regarding responding to consumer complaints and assisting in
resolving such complaints; and
(5) work with other Federal agencies to assist in
enforcement and compliance.
(b) Compliance.--
(1) In general.--The Secretary of Health and Human
Services, the Secretary of Labor, and the Secretary of the
Treasury, in consultation with the Director of the Centers for
Disease Control and Prevention, shall monitor compliance by
group health plans and health insurance issuers with coverage
requirements established under sections 2799A-11 of the Public
Health Service Act, 726 of the Employee Retirement Income
Security Act of 1974, and 9826 of the Internal Revenue Code of
1986 (as added by section 3(a)) and shall take appropriate
enforcement actions under such Acts and such Code.
(2) Insurer submissions to the secretary.--Beginning not
later than 1 year after the date of enactment of this Act, each
group health plan and health insurance issuer offering group or
individual health insurance coverage shall submit to the
Secretary of Health and Human Services, at such time as such
secretary, in coordination with the Secretary of Labor and the
Secretary of the Treasury, shall require, but not less
frequently than annually for the 10-year period beginning on
such date of enactment, data demonstrating compliance with the
coverage requirements described in paragraph (1), including
aggregate data on the number of claims received by such plans
and issuers for HIV prevention services and the cost-sharing
for enrollees with respect to such claims.
(3) Reports to congress.--Not later than 2 years after the
date of enactment of this Act and every 2 years thereafter for
the 10-year period beginning on such date of enactment, the
Secretary of Health and Human Services, the Secretary of Labor,
and the Secretary of the Treasury (collectively referred to in
this section as the ``Secretaries'') shall jointly submit to
Congress and make publicly available a report to assess the
prevalence of noncompliance with the coverage requirements
described in paragraph (1). Each such report shall include--
(A) aggregate information about group health plans
and health insurance issuers that the Secretaries
determine to be out of compliance with such
requirements; and
(B) steps the Secretaries have taken to address
incidences of such noncompliance.
(4) Definitions.--In this subsection, the terms ``group
health plan'', ``health insurance coverage'', and ``health
insurance issuer'' have the meanings given such terms in
section 2791 of the Public Health Service Act (42 U.S.C. 300gg-
91).
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