PrEP Access Act
Sponsored By: Representative Pocan, Mark [D-WI-2]
Introduced
Summary
Expand Medicare access to pharmacist-provided HIV prevention services. This bill would add pharmacist-provided HIV prevention services to Medicare Part B, letting pharmacists deliver and bill for PrEP, PEP, related counseling, medication administration, and clinical lab tests when state law authorizes those services.
Show full summary
- Medicare beneficiaries: People on Medicare could receive PrEP and PEP care from pharmacists with Part B coverage starting January 1, 2027, and patients cannot be balance-billed for those pharmacist services.
- Pharmacists: Pharmacists who are legally authorized by their state could furnish evaluation, management, screening, consultation, counseling, medication administration, and related diagnostic tests and bill Medicare for those services.
- Payment and coverage rules: Payment would be 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount, and Medicare would not pay for pharmacist services that are not reasonable and necessary for HIV prevention.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 0 costs, 1 mixed.
Medicare covers pharmacist HIV prevention
This bill would let pharmacists provide covered HIV prevention services under Medicare Part B starting January 1, 2027. The services would include evaluation, screening, PrEP and PEP counseling, medication administration, and related lab tests. The pharmacist must be legally authorized under State law. Medicare would pay 80% of the smaller of the pharmacist's charge or 85% of the usual Medicare amount. Pharmacists would be banned from balance-billing beneficiaries for these services. Medicare would not pay when a service is not reasonable and necessary to prevent or detect HIV.
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
Johnson (GA)
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
Cohen
TN • D
Sponsored 2/4/2026
Budzinski
IL • D
Sponsored 4/9/2026
Friedman
CA • D
Sponsored 4/9/2026
Pingree
ME • D
Sponsored 4/9/2026
Roll Call Votes
No roll call votes available for this bill.
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