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119-hr-7189119th CongressWALLET

PrEP Access Act

Sponsored By: Representative Pocan, Mark [D-WI-2]

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.

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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, Mark [D-WI-2]

WI • D

Cosponsors

  • Rep. Beatty, Joyce [D-OH-3]

    OH • D

    Sponsored 1/21/2026

  • Rep. Dean, Madeleine [D-PA-4]

    PA • D

    Sponsored 1/21/2026

  • Rep. Garcia, Robert [D-CA-42]

    CA • D

    Sponsored 1/21/2026

  • Rep. Garcia, Sylvia R. [D-TX-29]

    TX • D

    Sponsored 1/21/2026

  • Rep. Gottheimer, Josh [D-NJ-5]

    NJ • D

    Sponsored 1/21/2026

  • Del. Norton, Eleanor Holmes [D-DC-At Large]

    DC • D

    Sponsored 1/21/2026

  • Rep. Johnson, Henry C. "Hank" [D-GA-4]

    GA • D

    Sponsored 1/21/2026

  • Rep. Ramirez, Delia C. [D-IL-3]

    IL • D

    Sponsored 1/21/2026

  • Rep. Ross, Deborah K. [D-NC-2]

    NC • D

    Sponsored 1/21/2026

  • Rep. Torres, Ritchie [D-NY-15]

    NY • D

    Sponsored 1/21/2026

  • Rep. Watson Coleman, Bonnie [D-NJ-12]

    NJ • D

    Sponsored 1/21/2026

  • Rep. Balint, Becca [D-VT-At Large]

    VT • D

    Sponsored 2/4/2026

  • Rep. Cohen, Steve [D-TN-9]

    TN • D

    Sponsored 2/4/2026

  • Rep. Budzinski, Nikki [D-IL-13]

    IL • D

    Sponsored 4/9/2026

  • Rep. Friedman, Laura [D-CA-30]

    CA • D

    Sponsored 4/9/2026

  • Rep. Pingree, Chellie [D-ME-1]

    ME • D

    Sponsored 4/9/2026

  • Rep. Grijalva, Adelita S. [D-AZ-7]

    AZ • D

    Sponsored 8/3/2026

  • Rep. Cleaver, Emanuel [D-MO-5]

    MO • D

    Sponsored 8/3/2026

  • Rescom. Hernández, Pablo Jose [D-PR-At Large]

    PR • D

    Sponsored 8/3/2026

  • Rep. Jackson, Jonathan L. [D-IL-1]

    IL • D

    Sponsored 8/3/2026

  • Rep. Correa, J. Luis [D-CA-46]

    CA • D

    Sponsored 8/31/2026

Roll Call Votes

No roll call votes available for this bill.

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