PrEP Access and Coverage Act of 2026
Sponsored By: Senator Smith, Tina [D-MN]
Introduced
Summary
Guarantee broad access to PrEP and PEP across federal public and private health programs. The bill would create a statutory framework requiring coverage of FDA‑approved HIV prevention drugs, related laboratory tests, and clinical follow‑up while limiting cost‑sharing and removing most prior‑authorization barriers across Medicaid, Medicare, CHIP, FEHB, VA, DoD, Indian Health Service, and private plans.
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- People at risk and families: Would gain coverage for PrEP/PEP drugs, diagnostics, and monitoring with little or no cost‑sharing. HIPAA changes would let people use PrEP/PEP benefits on family plans without informing other plan members.
- Community providers and clinics: Establishes a PrEP/PEP funding program to award grants to states, tribes, Federally Qualified Health Centers, rural clinics, and other eligible entities for drugs, lab tests, outreach, adherence support, provider education, and program administration. Recipients must report annually and Congress would receive five‑year reports on grant impact.
- Insurers, employers, and regulators: Would require group health plans and issuers to submit annual claims and cost‑sharing data and lets HHS, Labor, and Treasury monitor compliance and issue guidance. The bill also bans life, disability, and long‑term care insurers from denying or pricing coverage based on PrEP/PEP use and creates a private right of action for violations.
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Bill Overview
Analyzed Economic Effects
9 provisions identified: 9 benefits, 0 costs, 0 mixed.
Federal employee plans: no PrEP cost
If enacted, health plans under the Federal Employees Health Benefits Program (FEHB) would have to cover FDA‑approved HIV prevention drugs, lab tests, and follow‑up with no cost‑sharing. This change would apply to FEHB plans and enrollees when the bill is enacted.
Medicaid and CHIP cover PrEP
If enacted, Medicaid would cover FDA‑approved HIV prevention drugs, lab tests, and follow‑up with no cost‑sharing starting when the bill is enacted. CHIP would be required to cover those services with no cost‑sharing starting January 1, 2027. States that must change their laws could have a later effective date under the bill's timing rules.
Medicare adds no-cost PrEP drugs
If enacted, Medicare Part B would cover HIV prevention drugs, tests, and follow‑up furnished on or after January 1, 2027, and the Part B deductible would not apply to those services. For Part D plan years beginning on or after January 1, 2027, covered HIV prevention drugs would have no Part D deductible, coinsurance, or other cost‑sharing.
Private plans must cover PrEP
If enacted, private group and individual health plans would have to cover FDA‑approved HIV prevention drugs, required lab tests, and clinical follow‑up per current clinical guidelines. Plans generally would not be allowed to require prior authorization for these services. A plan could require prior authorization for a drug only if it covers a therapeutically equivalent drug without prior authorization. These rules would apply when the bill is enacted.
VA and TRICARE stop PrEP copays
If enacted, VA would exclude medications used to prevent HIV from VA medication copays and would not charge for related labs or follow‑up. The bill would also require TRICARE to cover FDA‑approved HIV prevention drugs, tests, and follow‑up when enacted.
Plan reporting and legal enforcement
If enacted, group and individual health plans would have to submit data to HHS at least annually for ten years to show they follow the coverage rules. HHS, Labor, and Treasury would issue guidance and report to Congress every two years for ten years. The bill would also give individuals a private right to sue for violations and let a prevailing plaintiff recover costs and reasonable attorney's fees.
Grants and education to expand PrEP
If enacted, HHS would set up a grant program within one year to give funds to states, tribes, and community groups to expand PrEP and PEP access. Grants could pay for drugs, tests, follow‑up, outreach, provider training, and adherence support. HHS would also run public and provider education campaigns focused on high‑need communities, with authorization of appropriations for fiscal years 2026 through 2030.
Ban on PrEP discrimination by insurers
If enacted, life, disability, and long‑term care insurers could not deny, limit, or charge higher prices just because someone takes medication to prevent HIV. State insurance regulators would enforce these prohibitions under state law.
Privacy on family plans for PrEP
If enacted, the HHS Secretary would change HIPAA rules so people on family health plans could get PrEP or PEP without the primary policyholder being informed. The change aims to protect the privacy of family plan members using HIV prevention drugs.
Sponsors & CoSponsors
Sponsor
Smith, Tina [D-MN]
MN • D
Cosponsors
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
Amy Klobuchar
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
John Hickenlooper
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
Roll Call Votes
No roll call votes available for this bill.
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