PrEP and PEP are Prevention Act
Sponsored By: Representative Waters
Introduced
Summary
This bill would require no-cost coverage for HIV prevention services. It sets a single definition that covers FDA-approved prevention drugs (including PrEP and PEP), administration fees, labs and diagnostics, counseling, and clinical follow-up per U.S. Public Health Service guidelines.
Show full summary
- Private plan enrollees would get no-cost coverage for HIV prevention drugs and related services. Plans could not require preauthorization for these services except in narrow cases when a therapeutically equivalent drug is covered without preauthorization.
- People on federal programs would see expanded no-cost coverage. The bill would add HIV prevention services to Medicare Part B and Part D and remove Part B coinsurance and deductible for these services while eliminating Part D cost-sharing for prevention drugs, and it would require Federal Employees Health Benefits plans to cover these services with no cost-sharing.
- Medicaid and CHIP enrollees would gain these services as mandatory benefits with no cost-sharing. Implementation generally starts January 1 of the first calendar year after enactment with limited state delays if state law changes are needed.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 4 benefits, 0 costs, 0 mixed.
Medicaid and CHIP HIV prevention at no cost
If enacted, Medicaid and CHIP would have to cover HIV prevention services like PrEP and PEP. This would include lab tests, counseling, and follow-up visits. States could not charge copays for these services in Medicaid or CHIP. These changes would start on January 1 of the first calendar year after enactment, unless a needed state law change delays it.
Medicare HIV prevention at no cost
If enacted, Medicare would cover HIV prevention services like PrEP and PEP. Under Part B, most services would be paid at 100%, and the Part B deductible would not apply to prevention drugs. Some hospital outpatient department rules could still apply. Under Part D, there would be no deductible or coinsurance for HIV prevention drugs. Part B changes would apply to items and services furnished on or after January 1 of the first calendar year after enactment, and Part D changes would start with the first plan year after enactment.
No-cost HIV prevention in FEHB plans
If enacted, FEHB plans would have to cover HIV prevention drugs and related services at no cost. Coverage would include admin fees, lab work, counseling, and follow-up per current guidelines. This would start with the first plan year after enactment.
No-cost HIV prevention in private plans
If enacted, group and individual health plans would have to cover HIV prevention drugs and related tests, counseling, and follow-up at no cost. Plans could not require prior approval, unless they offer a similar drug without it. This would start with the first plan year after enactment.
Sponsors & CoSponsors
Sponsor
Waters
CA • D
Cosponsors
Garcia (CA)
CA • D
Sponsored 9/4/2025
Nadler
NY • D
Sponsored 9/4/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 9/4/2025
Thompson (MS)
MS • D
Sponsored 9/4/2025
Krishnamoorthi
IL • D
Sponsored 9/4/2025
Garcia (TX)
TX • D
Sponsored 9/4/2025
Velazquez
NY • D
Sponsored 9/4/2025
Sewell
AL • D
Sponsored 9/4/2025
Carson
IN • D
Sponsored 9/4/2025
Jackson (IL)
IL • D
Sponsored 9/4/2025
Titus
NV • D
Sponsored 9/4/2025
Johnson (GA)
GA • D
Sponsored 9/4/2025
McIver
NJ • D
Sponsored 9/4/2025
Beatty
OH • D
Sponsored 9/4/2025
Cleaver
MO • D
Sponsored 9/4/2025
Cohen
TN • D
Sponsored 9/4/2025
Wilson (FL)
FL • D
Sponsored 9/4/2025
Simon
CA • D
Sponsored 9/4/2025
Thanedar
MI • D
Sponsored 9/4/2025
Mullin
CA • D
Sponsored 9/4/2025
Ramirez
IL • D
Sponsored 9/4/2025
Barragan
CA • D
Sponsored 9/4/2025
Watson Coleman
NJ • D
Sponsored 9/4/2025
Tlaib
MI • D
Sponsored 9/4/2025
Clarke (NY)
NY • D
Sponsored 9/4/2025
Williams (GA)
GA • D
Sponsored 9/4/2025
Latimer
NY • D
Sponsored 9/9/2025
Moore (WI)
WI • D
Sponsored 9/9/2025
Randall
WA • D
Sponsored 9/9/2025
Figures
AL • D
Sponsored 9/9/2025
Ross
NC • D
Sponsored 9/9/2025
Pocan
WI • D
Sponsored 10/28/2025
Johnson (TX)
TX • D
Sponsored 12/3/2025
Kelly (IL)
IL • D
Sponsored 2/2/2026
Roll Call Votes
No roll call votes available for this bill.
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