H.R. 7189: PrEP Access Act

This bill, known as the **PrEP Access Act**, proposes several amendments to the Social Security Act aimed at enhancing access to HIV prevention services through pharmacists for individuals covered by Medicare. Below is a summary of the key provisions of the bill:

1. Coverage for Pharmacist-Provided Services

The bill seeks to add coverage for certain HIV prevention services that are provided by pharmacists under Medicare Part B. This includes:

• Services that are legally authorized for pharmacists to provide under state law.
• Services related to the preventive measures against HIV, such as evaluation, management, screening, counseling, and the administration of medications like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
• Clinical diagnostic laboratory tests associated with these prevention efforts.

2. Payment Structure

The bill introduces a payment structure for these pharmacist-provided services. Under the new provisions:

• Medicare will pay 80% of the lesser of the actual charge for the services or 85% of the amount determined under the payment basis for similar services.

3. Prohibition of Balance Billing

The legislation aims to prevent balance billing for the services provided by pharmacists. This means that pharmacists would not be able to charge patients for the difference between what Medicare pays and their own fee for services rendered.

4. Conforming Amendments

Several conforming amendments are made throughout the bill to ensure that all references to healthcare practitioners are inclusive of pharmacists, ensuring that pharmacists are recognized as providers of these vital services.

5. Implementation Timeline

The provisions outlined in the bill are set to take effect on January 1, 2027, allowing time for the necessary regulatory changes and implementation to occur.

Relevant Companies

• PFE (Pfizer Inc.): Pfizer manufactures PrEP medications, and this bill could lead to increased demand for these products as access to pharmacy-provided prevention services expands.
• GILD (Gilead Sciences, Inc.): Gilead is another significant manufacturer of PrEP medication and may see changes in sales and distribution resulting from the increased accessibility through pharmacists.