PrEP Access and Coverage Act of 2026
Sponsored By: Representative Takano
Introduced
Summary
Protects and expands access to HIV prevention by banning insurance discrimination for people who take PrEP or PEP and by funding education, grants, and stronger privacy rules. This bill pairs nondiscrimination rules with outreach, a grant program, and data and enforcement steps to boost use of PrEP and PEP in high‑need communities.
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- People at risk and uninsured: Establishes an HHS grant program for states, territories, tribes, and community providers to cover FDA‑approved PrEP/PEP drugs, labs, clinical follow‑up, outreach, and adherence support. Grants prioritize areas with large uninsured or underinsured populations and are authorized for fiscal years 2026 through 2030.
- Families and policyholders: Makes it unlawful for life, disability, and long‑term care insurers to deny, limit, or raise rates because someone uses PrEP or PEP. It also directs HHS to change HIPAA rules so family plan members can use PrEP/PEP without other enrollees or the policyholder being notified.
- Providers and public health system: Directs HHS, through the Centers for Disease Control and Prevention and the Health Resources and Services Administration (HRSA), to run public and provider education campaigns focused on high‑need communities and to evaluate effectiveness. Insurers must begin submitting compliance and claims data one year after enactment and federal agencies will report noncompliance to Congress every two years for ten years.
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 8 benefits, 0 costs, 0 mixed.
Medicare drops PrEP cost‑sharing
This bill would add HIV prevention drugs and related care to Medicare Part B and Part D. For services and drugs furnished or in plan years on or after January 1, 2027, beneficiaries would not pay the Part B deductible or coinsurance, and Part D drugs for prevention would have no deductible or coinsurance.
Insurers can't penalize PrEP users
This bill would make it unlawful for life, disability, and long‑term care insurers to deny coverage, limit eligibility, or raise premiums because someone takes medication to prevent HIV. States would enforce these rules under state insurance law. The change would take effect on enactment.
Federal employee plans cover PrEP
This bill would require Federal Employees Health Benefits plans to cover FDA‑approved HIV prevention drugs and related lab and follow‑up care with no cost‑sharing. The rule would apply for plan years beginning on or after January 1, 2027.
Medicaid and CHIP cover PrEP
This bill would require Medicaid and CHIP to cover HIV prevention drugs (PrEP/PEP) and related lab and follow‑up care. For Medicaid, these services would be added upon enactment and would not have cost‑sharing. For CHIP, targeted low‑income children and pregnant women would get these services with no cost‑sharing starting January 1, 2027, subject to state legislative delay rules.
No PrEP cost‑sharing for military
This bill would require TRICARE to cover HIV prevention drugs and related services with no cost‑sharing for plan years beginning on or after January 1, 2027. It would also stop the VA from charging medication copayments or billing for labs, administrative fees, or clinical follow‑up tied to prevention drugs starting on the same schedule.
Private plans: coverage, privacy, reporting
This bill would require private group and individual health plans to cover FDA‑approved HIV prevention drugs and related care with no cost‑sharing for plan years beginning on or after January 1, 2027. Group plans generally could not require prior authorization except in a narrow therapeutically equivalent case. HHS and CDC would issue guidance and technical help, group plans and issuers would submit compliance data at least annually starting within one year, and HHS would change HIPAA rules so family‑plan users could get PrEP/PEP without telling the policyholder.
Grants, IHS funding, and education
This bill would create a federal grant program within one year to fund PrEP and PEP programs for States, Tribes, territories, and eligible community providers. Grants could pay for drugs, labs, outreach, adherence services, and navigator staff. The bill would also fund the Indian Health Service to cover prevention drugs and care. HHS would run public and provider education campaigns starting on enactment and authorize funding for 2026–2030. HHS would report on grants for the first five years after the program begins.
Right to sue and legal priority
This bill would let any person harmed by a violation sue in federal or other competent courts, alone or as a class. A prevailing plaintiff could recover costs and reasonable attorney fees. The bill would also say its rules apply even if another law seems to conflict. These take effect on enactment.
Sponsors & CoSponsors
Sponsor
Takano
CA • D
Cosponsors
Pocan
WI • D
Sponsored 3/5/2026
Balint
VT • D
Sponsored 3/5/2026
Roll Call Votes
No roll call votes available for this bill.
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