PrEP Access and Coverage Act of 2026
Sponsored By: Representative Takano, Mark [D-CA-39]
Introduced
Summary
No-cost coverage for FDA-approved HIV prevention drugs. This bill would create a federal framework to expand access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) by requiring coverage and limiting cost-sharing across private insurance, Medicare, Medicaid, VA, DoD/TRICARE, the Indian Health Service, and the Federal Employees Health Benefits program. It also funds education and grant programs, protects confidentiality for family plans, bans insurer discrimination for using prevention drugs, and sets enforcement and reporting rules.
Show full summary
- People and families: People in family plans could get PrEP/PEP without cost-sharing and without other enrollees being notified. Veterans, Medicare enrollees, Medicaid and CHIP beneficiaries, TRICARE users, and IHS patients get covered drugs, labs, and follow-up with reduced or no cost-sharing.
- Providers and public health programs: The bill would fund national public and provider education campaigns and create a grant program for states, tribes, community clinics, and federally qualified health centers to expand PrEP/PEP services. Grants and campaign funding are authorized for fiscal years 2026–2030 and the grant program must be established within one year.
- Insurers and enforcement: Plans could not impose preauthorization except in narrow therapeutic-equivalence cases. Insurers must submit compliance data annually for 10 years starting within a year, HHS and other agencies would oversee enforcement, and the law creates a private right of action and bans life, disability, and long-term care pricing or denials based on taking HIV prevention medication.
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
11 provisions identified: 10 benefits, 0 costs, 1 mixed.
Enforcement, reporting, and lawsuits
The bill would require HHS (with CDC) to issue guidance and billing tools and to give technical help to states and providers to enforce the coverage rules. Group health plans and issuers would have to submit aggregate data on HIV prevention claims and cost‑sharing starting within one year and at least annually for 10 years. HHS, Labor, and Treasury would report to Congress every two years for 10 years on compliance and enforcement. Any person harmed by a violation would be able to sue and recover costs and reasonable attorney fees.
Federal employee plans cover PrEP/PEP
If you are covered by the Federal Employees Health Benefits program, FEHB plans would have to cover FDA‑approved HIV prevention drugs, labs, and follow‑up with no cost‑sharing. This requirement would apply to plan years beginning on or after January 1, 2027.
Funding for Indian Health Service care
The bill would authorize funding so the Indian Health Service and tribal programs can provide FDA‑approved HIV prevention drugs, labs, and clinical follow‑up. The provision authorizes 'such sums as are necessary' and would apply on or after January 1, 2027.
Medicare drug and services coverage
If you are on Medicare, HIV prevention drugs and related labs and follow‑up would be added to Part B and as covered Part D drugs. Part B items would be paid without beneficiary coinsurance for these services and Part B deductibles would not apply to HIV prevention drugs. For Part D, plan years beginning on or after January 1, 2027, the Part D deductible and other cost‑sharing would not apply to covered HIV prevention drugs.
No-cost PrEP/PEP in private plans
If you have private group or individual health insurance, your plan would have to cover any FDA‑approved drug to prevent HIV and related labs, administrative fees, and clinical follow‑up with no cost‑sharing. Plans could not require prior authorization for these services except in a narrow case when they already cover a therapeutically equivalent drug without prior authorization. These rules would apply for plan years beginning on or after January 1, 2027.
TRICARE covers PrEP/PEP with no cost
If you are a TRICARE beneficiary, TRICARE would have to cover FDA‑approved HIV prevention drugs, labs, and clinical follow‑up with no cost‑sharing. This change would apply for plan years or program implementation beginning on or after January 1, 2027.
VA removes copays for PrEP/PEP
If you get VA health care, VA would add FDA‑approved HIV prevention drugs and related labs and follow‑up to its preventive services and veterans would not owe copays for those drugs or associated services. This would apply for plan years or program changes beginning on or after January 1, 2027.
Grants and education for PrEP/PEP
The Secretary would set up a grant program within one year to help states, territories, tribes, clinics, and community groups run PrEP and PEP programs. Grants could pay for FDA‑approved drugs, labs, outreach, provider training, and staff like PrEP navigators. HHS would also lead culturally competent public and provider education campaigns and evaluate them, with funding authorized for fiscal years 2026 through 2030. The bill also defines PrEP and PEP as FDA‑approved drugs for pre‑ or post‑exposure prevention for these programs.
Medicaid and CHIP coverage changes
If you are on Medicaid or CHIP, HIV prevention drugs, related labs, and clinical follow‑up would become required Medicaid and CHIP benefits and States could not charge cost‑sharing for them. The coverage requirement would begin January 1, 2027. A State may delay implementation until the first day of the first calendar quarter after the close of that State's next regular legislative session if state law changes are needed.
Ban on insurance pricing for PrEP use
If you apply for life, disability, or long‑term care insurance, insurers could not deny you, limit coverage, or charge higher premiums just because you take medication to prevent HIV. State insurance regulators would enforce this rule under state law.
Privacy for family plan users
The HHS Secretary would change HIPAA rules so someone on a family health plan can get HIV prevention drugs without the primary policyholder or other family members being notified. This would protect privacy when people seek PrEP/PEP but would not itself change coverage or cost rules.
Sponsors & CoSponsors
Sponsor
Takano, Mark [D-CA-39]
CA • D
Cosponsors
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 3/5/2026
Rep. Balint, Becca [D-VT-At Large]
VT • D
Sponsored 3/5/2026
Mullin
CA • D
Sponsored 4/13/2026
Barragan
CA • D
Sponsored 4/20/2026
Rep. Scanlon, Mary Gay [D-PA-5]
PA • D
Sponsored 4/20/2026
DelBene
WA • D
Sponsored 4/20/2026
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 4/20/2026
Rep. Moskowitz, Jared [D-FL-23]
FL • D
Sponsored 4/20/2026
Rep. Quigley, Mike [D-IL-5]
IL • D
Sponsored 4/20/2026
Bonamici
OR • D
Sponsored 4/20/2026
Rep. Velázquez, Nydia M. [D-NY-7]
NY • D
Sponsored 4/20/2026
Rep. Stanton, Greg [D-AZ-4]
AZ • D
Sponsored 4/20/2026
Rep. Moulton, Seth [D-MA-6]
MA • D
Sponsored 4/20/2026
Rep. Torres, Norma J. [D-CA-35]
CA • D
Sponsored 4/20/2026
Casten
IL • D
Sponsored 4/20/2026
Rep. Dingell, Debbie [D-MI-6]
MI • D
Sponsored 4/20/2026
Rep. García, Jesús G. "Chuy" [D-IL-4]
IL • D
Sponsored 4/20/2026
Sewell
AL • D
Sponsored 4/20/2026
Carson
IN • D
Sponsored 4/20/2026
Rep. Wasserman Schultz, Debbie [D-FL-25]
FL • D
Sponsored 4/20/2026
Rep. Hayes, Jahana [D-CT-5]
CT • D
Sponsored 4/20/2026
Rep. Davids, Sharice [D-KS-3]
KS • D
Sponsored 4/22/2026
Rep. Dean, Madeleine [D-PA-4]
PA • D
Sponsored 4/22/2026
Rep. Titus, Dina [D-NV-1]
NV • D
Sponsored 4/22/2026
Rep. Lieu, Ted [D-CA-36]
CA • D
Sponsored 4/27/2026
Pingree
ME • D
Sponsored 5/14/2026
Rep. Garcia, Robert [D-CA-42]
CA • D
Sponsored 5/14/2026
Cohen
TN • D
Sponsored 5/14/2026
Fletcher
TX • D
Sponsored 5/14/2026
Rep. Matsui, Doris O. [D-CA-7]
CA • D
Sponsored 5/14/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov