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119-s-3990119th CongressWALLET
PrEP Access and Coverage Act of 2026
Sponsored By: Senator Smith, Tina [D-MN]
Introduced
Summary
Guarantees no-cost access to PrEP and PEP across public and private health coverage. This bill would require plans to cover FDA-approved HIV prevention drugs, diagnostics, counseling, and follow-up, ban most prior authorization rules, strengthen privacy for family plans, bar insurers from penalizing people who take PrEP/PEP, and fund grants and education to boost access and uptake.
Show full summary
- People and families would get FDA-approved PrEP and PEP plus related tests, counseling, lab work, and adherence services with no cost-sharing in covered plans and, for most plans, no prior authorization. It would also keep PrEP/PEP use private within family health plans so other enrollees do not see that information.
- Medicare, Medicaid, CHIP, VA, and DoD beneficiaries would see expanded prevention coverage. Medicare would add prevention services to Part B with no coinsurance or deductible and place prevention drugs in Part D with zero cost-sharing for plan years after January 1, 2027, while Medicaid and CHIP would align coverage and VA and DoD would remove cost-sharing as specified.
- States, tribes, community health centers, rural clinics, and nonprofit providers would be eligible for grants to pay for drugs, testing, outreach, administration, and adherence services, with programs required within 1 year of enactment. The bill would fund national public and provider education campaigns through FY2026–2030 and require evaluations and annual reports for five years.
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Bill Overview
Analyzed Economic Effects
10 provisions identified: 10 benefits, 0 costs, 0 mixed.
Insurers cannot penalize PrEP users
If enacted, life, disability, and long-term care insurers could not deny coverage, change terms, or charge higher premiums just because someone takes medication to prevent HIV. State insurance regulators would enforce these non-discrimination rules upon enactment.
Free PrEP for federal, military, veterans
If enacted, Federal Employees Health Benefits (FEHB) plans would have to cover HIV prevention drugs and related care with no cost-sharing for plan years starting January 1, 2027. TRICARE would also cover HIV prevention with no cost-sharing for plan years starting January 1, 2027. The VA would stop charging copays for HIV prevention drugs, tests, and follow-up upon enactment.
Medicaid and CHIP cover PrEP free
If enacted, Medicaid would explicitly cover FDA-approved HIV prevention drugs, lab tests, and follow-up care upon enactment. Medicaid beneficiaries could not be charged copays or other cost-sharing for those covered HIV prevention services. CHIP would also be required to cover the same HIV prevention services with no cost-sharing starting January 1, 2027, though States that need new state law could delay until after their next legislative session ends.
Medicare covers PrEP with no drug fees
If enacted, Medicare Part B would treat HIV prevention services as covered Part B benefits for services furnished on or after January 1, 2027. For Part D, plan years beginning on or after January 1, 2027 would have no deductible, coinsurance, or other cost-sharing for covered HIV prevention drugs.
No preapproval and no-cost PrEP
If enacted, group health plans would generally have to cover FDA-approved PrEP and PEP drugs and related services without patient cost-sharing for plan years starting January 1, 2027. The bill would also bar most preauthorization rules for those drugs starting with plan years that begin January 1, 2027. A plan could impose preauthorization for a specific drug only if it covers a therapeutically equivalent drug without preauthorization.
Enforcement, reporting, and private lawsuits
If enacted, HHS and CDC would issue guidance, monitor compliance, and require group health plans to submit annual compliance data for ten years starting within one year of enactment. The bill would also let people sue in court if harmed by violations and recover costs and attorney fees. HHS must report to Congress about noncompliant plans starting two years after enactment and every two years for ten years.
Grant money and public PrEP campaigns
If enacted, HHS would set up a grant program within one year to fund state, tribal, and community PrEP and PEP programs. Grants could pay for drugs, labs, outreach, staff, and adherence services. The bill would also fund national public and provider education campaigns about PrEP/PEP for fiscal years 2026–2030.
Indian Health Service PrEP funding
If enacted, the Indian Health Service would be directed to provide FDA-approved HIV prevention drugs and related lab and follow-up services. The bill authorizes appropriations of such sums as are necessary to carry out this IHS funding upon enactment.
Privacy for family-plan PrEP use
If enacted, HHS would change HIPAA-related rules so people on a family health plan can get PrEP or PEP without the primary policyholder being told. The change is intended to prevent disclosures like explanations of benefits that would reveal PrEP use and would take effect upon enactment.
Which breast screening rules apply
If enacted, the bill would say which U.S. Preventive Services Task Force breast cancer screening recommendations count as the current guidance for this law and other laws. It treats current USPSTF guidance as current except for recommendations from around November 2009. This clarification would take effect upon enactment.
Sponsors & CoSponsors
Sponsor
Smith, Tina [D-MN]
MN • D
Cosponsors
Sen. Warnock, Raphael G. [D-GA]
GA • D
Sponsored 9/30/2026
Sen. Gallego, Ruben [D-AZ]
AZ • D
Sponsored 9/30/2026
Sen. Whitehouse, Sheldon [D-RI]
RI • D
Sponsored 9/30/2026
Sen. Durbin, Richard J. [D-IL]
IL • D
Sponsored 9/24/2026
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 9/24/2026
Sen. Schiff, Adam B. [D-CA]
CA • D
Sponsored 3/4/2026
Sen. Alsobrooks, Angela D. [D-MD]
MD • D
Sponsored 3/4/2026
Sen. Baldwin, Tammy [D-WI]
WI • D
Sponsored 3/4/2026
Sen. Blumenthal, Richard [D-CT]
CT • D
Sponsored 3/4/2026
Sen. Booker, Cory A. [D-NJ]
NJ • D
Sponsored 3/4/2026
Sen. Coons, Christopher A. [D-DE]
DE • D
Sponsored 3/4/2026
Sen. Cortez Masto, Catherine [D-NV]
NV • D
Sponsored 3/4/2026
Sen. Duckworth, Tammy [D-IL]
IL • D
Sponsored 3/4/2026
Sen. Kim, Andy [D-NJ]
NJ • D
Sponsored 3/4/2026
Sen. Klobuchar, Amy [D-MN]
MN • D
Sponsored 3/4/2026
Sen. Markey, Edward J. [D-MA]
MA • D
Sponsored 3/4/2026
Sen. Merkley, Jeff [D-OR]
OR • D
Sponsored 3/4/2026
Sen. Padilla, Alex [D-CA]
CA • D
Sponsored 3/4/2026
Sen. Reed, Jack [D-RI]
RI • D
Sponsored 3/4/2026
Sen. Rosen, Jacky [D-NV]
NV • D
Sponsored 3/4/2026
Sen. Shaheen, Jeanne [D-NH]
NH • D
Sponsored 3/4/2026
Sen. Warren, Elizabeth [D-MA]
MA • D
Sponsored 3/4/2026
Sen. Wyden, Ron [D-OR]
OR • D
Sponsored 3/4/2026
Sen. Hickenlooper, John W. [D-CO]
CO • D
Sponsored 3/4/2026
Sen. Ossoff, Jon [D-GA]
GA • D
Sponsored 3/25/2026
Sen. Heinrich, Martin [D-NM]
NM • D
Sponsored 3/25/2026
Sen. Bennet, Michael F. [D-CO]
CO • D
Sponsored 4/29/2026
Sen. Murray, Patty [D-WA]
WA • D
Sponsored 8/4/2026
Sen. Gillibrand, Kirsten E. [D-NY]
NY • D
Sponsored 8/4/2026
Sen. Welch, Peter [D-VT]
VT • D
Sponsored 9/14/2026
Sen. Van Hollen, Chris [D-MD]
MD • D
Sponsored 9/14/2026
Sen. Hassan, Margaret Wood [D-NH]
NH • D
Sponsored 9/14/2026
Sen. Warner, Mark R. [D-VA]
VA • D
Sponsored 9/14/2026
Sen. Kelly, Mark [D-AZ]
AZ • D
Sponsored 9/14/2026
Sen. Blunt Rochester, Lisa [D-DE]
DE • D
Sponsored 9/22/2026
Sen. Hirono, Mazie K. [D-HI]
HI • D
Sponsored 9/22/2026
Sen. Murphy, Christopher [D-CT]
CT • D
Sponsored 9/22/2026
Sen. Sanders, Bernard [I-VT]
VT • I
Sponsored 9/22/2026
Sen. Slotkin, Elissa [D-MI]
MI • D
Sponsored 9/23/2026
Sen. Fetterman, John [D-PA]
PA • D
Sponsored 9/23/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov