PrEP Access Act
Sponsored By: Representative Pocan
Introduced
Summary
The PrEP Access Act would let Medicare Part B cover and pay for pharmacist-delivered HIV prevention services. It expands where beneficiaries can get PrEP, PEP, counseling, medication administration, and related lab tests.
Show full summary
- Medicare enrollees could receive PrEP and PEP, counseling, and related clinical lab tests from pharmacists when state law permits.
- Pharmacists who are legally authorized by their state could furnish evaluation, management, medication administration, and related diagnostic testing for HIV prevention and bill Medicare Part B.
- Medicare payment would equal 80% of either the pharmacist's actual charge or 85% of the physician fee schedule rate, whichever is less. Pharmacists would be prohibited from balance billing and the rule applies to services furnished on or after January 1, 2027.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Medicare coverage for pharmacist PrEP
If enacted, Medicare Part B would cover pharmacist-provided HIV prevention services starting January 1, 2027. You could get evaluation, screening, counseling, PrEP or PEP medication, and related lab tests from a pharmacist if state law allows the pharmacist to provide them. The bill would also ban pharmacists from balance billing Medicare beneficiaries for these Part B services. Services that are not reasonable and necessary to prevent or detect HIV would not be covered.
Pharmacist payment rules for PrEP
If enacted, Medicare would pay pharmacists for HIV prevention services using a set formula starting January 1, 2027. Payment would equal 80% of the lesser of the pharmacist's actual charge or 85% of the Medicare fee for the same service. That payment rule would likely reduce pharmacist reimbursement compared with standard physician-based fees and may change beneficiary coinsurance.
Sponsors & CoSponsors
Sponsor
Pocan
WI • D
Cosponsors
Beatty
OH • D
Sponsored 1/21/2026
Dean (PA)
PA • D
Sponsored 1/21/2026
Garcia (CA)
CA • D
Sponsored 1/21/2026
Garcia (TX)
TX • D
Sponsored 1/21/2026
Gottheimer
NJ • D
Sponsored 1/21/2026
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 1/21/2026
Johnson (GA)
GA • D
Sponsored 1/21/2026
Ramirez
IL • D
Sponsored 1/21/2026
Ross
NC • D
Sponsored 1/21/2026
Torres (NY)
NY • D
Sponsored 1/21/2026
Watson Coleman
NJ • D
Sponsored 1/21/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in