H.R. 5127: PrEP and PEP are Prevention Act
The bill known as the PrEP and PEP are Prevention Act aims to enhance coverage and access to HIV prevention services across various health care programs. Below are the main components of what the bill proposes:
No-Cost Coverage for HIV Prevention Services
The bill mandates that:
- Health insurance plans must provide no-cost coverage for certain FDA-approved prescription drugs used for HIV prevention, specifically pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
- This coverage includes related services such as administrative fees, laboratory diagnostics, counseling on HIV prevention, and clinical monitoring.
- Health plans cannot impose preauthorization requirements for these services, ensuring that beneficiaries can access them without additional hurdles.
Changes to Medicare
The bill introduces several amendments to Medicare, including:
- Includes HIV prevention services under Medicare Part B, thereby covering the aforementioned drugs and related services without cost-sharing like coinsurance or deductibles.
- Ensures that the first dollar spent on HIV prevention services is fully covered under Medicare, beginning on January 1 of the first calendar year after enactment.
Medicaid and CHIP Updates
Similar provisions are extended to Medicaid and the Children's Health Insurance Program (CHIP) by:
- Adding HIV prevention services to the list of mandatory benefits under both programs.
- Eliminating any cost-sharing, ensuring that individuals covered by Medicaid and CHIP have full access to these services.
Federal Employees Health Benefits Program Modifications
The bill requires that health plans under the Federal Employees Health Benefits Program also include:
- No-cost coverage for FDA-approved HIV prevention drugs and associated services, effective from the first plan year after enactment.
Effective Dates
The provisions will generally take effect with the first plan year that starts after the enactment of the bill, with specific adjustments allowed for state legislatures if required.
Relevant Companies
- GILD: Gilead Sciences is known for developing PrEP medications such as Truvada and Descovy. Changes in coverage could significantly impact their sales and market access.
- ABBV: AbbVie has developed treatments related to HIV. The bill could affect their presence in the preventative care sector as medications are more broadly covered under insurance plans.
This is an AI-generated summary of the bill text. There may be mistakes.
Sponsors
35 bill sponsors
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TrackMaxine Waters
Sponsor
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TrackNanette Diaz Barragán
Co-Sponsor
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TrackJoyce Beatty
Co-Sponsor
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TrackAndré Carson
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TrackYvette D. Clarke
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TrackEmanuel Cleaver
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TrackSteve Cohen
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TrackShomari Figures
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TrackRobert Garcia
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TrackSylvia R. Garcia
Co-Sponsor
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TrackJonathan L. Jackson
Co-Sponsor
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TrackJulie Johnson
Co-Sponsor
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TrackHenry C. "Hank" Johnson, Jr.
Co-Sponsor
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TrackRobin L. Kelly
Co-Sponsor
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TrackRaja Krishnamoorthi
Co-Sponsor
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TrackGeorge Latimer
Co-Sponsor
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TrackLaMonica McIver
Co-Sponsor
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TrackGwen Moore
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TrackKevin Mullin
Co-Sponsor
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TrackJerrold Nadler
Co-Sponsor
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TrackEleanor Holmes Norton
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TrackMark Pocan
Co-Sponsor
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TrackDelia C. Ramirez
Co-Sponsor
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TrackEmily Randall
Co-Sponsor
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TrackDeborah K. Ross
Co-Sponsor
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TrackTerri A. Sewell
Co-Sponsor
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TrackLateefah Simon
Co-Sponsor
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TrackShri Thanedar
Co-Sponsor
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TrackBennie G. Thompson
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TrackDina Titus
Co-Sponsor
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TrackRashida Tlaib
Co-Sponsor
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TrackNydia M. Velázquez
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TrackBonnie Watson Coleman
Co-Sponsor
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TrackNikema Williams
Co-Sponsor
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TrackFrederica S. Wilson
Co-Sponsor
Actions
2 actions
| Date | Action |
|---|---|
| Sep. 04, 2025 | Introduced in House |
| Sep. 04, 2025 | 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. |
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