PrEP Access Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7189 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 7189

To amend title XVIII of the Social Security Act to provide coverage for 
  certain HIV prevention services furnished by pharmacists under the 
                           Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 21, 2026

  Mr. Pocan (for himself, Mrs. Beatty, Ms. Dean of Pennsylvania, Mr. 
Garcia of California, Ms. Garcia of Texas, Mr. Gottheimer, Ms. Norton, 
Mr. Johnson of Georgia, Mrs. Ramirez, Ms. Ross, Mr. Torres of New York, 
   and Mrs. Watson Coleman) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committee on Ways and Means, 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 XVIII of the Social Security Act to provide coverage for 
  certain HIV prevention services furnished by pharmacists under the 
                           Medicare program.

    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 Act''.

SEC. 2. COVERAGE OF PHARMACIST-PROVIDED HIV PREVENTION SERVICES UNDER 
              MEDICARE PART B.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) in subparagraph (JJ), by inserting ``and'' 
                after the semicolon; and
                    (B) by adding at the end the following new 
                subparagraph:
            ``(KK) pharmacist-provided HIV prevention services (as 
        defined in subsection (nnn));''; and
            (2) by adding at the end the following new subsection:
    ``(nnn) Pharmacist-provided HIV Prevention Services.--The term 
`pharmacist-provided HIV prevention services' means such services 
furnished by a pharmacist, and such services and supplies furnished as 
incident to the pharmacist's service, as would otherwise be covered if 
furnished by a physician or as an incident to a physicians' service 
that--
            ``(1) the pharmacist is legally authorized to furnish under 
        State law; and
            ``(2) are services related to the prevention of human 
        immunodeficiency virus, including evaluation, management, 
        screening, consultation, and counseling services related to--
                    ``(A) pre-exposure prophylaxis, post-exposure 
                prophylaxis, or other evidence-based interventions for 
                the prevention of human immunodeficiency virus;
                    ``(B) medication administration for such 
                interventions; or
                    ``(C) clinical diagnostic laboratory tests related 
                to such interventions.''.
    (b) Payment.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and (HH)'' and inserting ``(HH)''; and
            (2) by inserting before the semicolon at the end ``, and 
        (II) with respect to pharmacist-provided HIV prevention 
        services (as defined in section 1861(nnn)), the amounts paid 
        shall be equal to 80 percent of the lesser of (i) the actual 
        charge for the services or (ii) 85 percent of the amount 
        determined under the payment basis under section 1848 for such 
        services''.
    (c) Prohibition on Balance Billing for Pharmacist Services.--
Section 1842(b)(18) of the Social Security Act (42 U.S.C. 1395u(b)(18)) 
is amended--
            (1) in subparagraph (A), by inserting ``or a pharmacist'' 
        after ``a practitioner described in subparagraph (C)'';
            (2) in subparagraph (B)--
                    (A) by inserting ``, pharmacist,'' after ``a 
                practitioner described in subparagraph (C)''; and
                    (B) in the third sentence--
                            (i) by inserting ``, pharmacist,'' after 
                        ``a practitioner''; and
                            (ii) by inserting ``, pharmacist,'' after 
                        ``the practitioner''; and
            (3) in subparagraph (D), by inserting ``or a pharmacist'' 
        after ``a practitioner described in subparagraph (C)''.
    (d) Conforming Amendment.--Section 1862(a)(1) of the Social 
Security Act (42 U.S.C. 1395y(a)(1)) is amended--
            (1) in subparagraph (O), by striking ``and'' at the end;
            (2) in subparagraph (P), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(Q) in the case of pharmacist-provided HIV prevention 
        services (as defined in section 1861(nnn)), which are not 
        reasonable and necessary for the prevention or detection of 
        human immunodeficiency virus;''.
    (e) Application.--The amendments made by this section shall apply 
to items and services furnished on or after January 1, 2027.
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