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MaineLD 1687132nd Maine Legislature (2025-2026)HouseWALLET

An Act to Clarify and Increase Access to HIV Prevention Medications

Sponsored By: Matt Moonen (Democratic)

Became Law

HEALTH CARE PERSONNELHEALTH CARE PERSONNEL - PHARMACISTS

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 1 benefits, 0 costs, 3 mixed.

MaineCare pays pharmacists for HIV prevention drugs

Beginning January 1, 2027, MaineCare pays pharmacists to prescribe, dispense, and give HIV prevention drugs. Pharmacists can bill MaineCare directly and are listed as the provider. The Department must create a MaineCare payment model by January 1, 2027 to increase access. If federal approval is needed, the state must apply to CMS by January 1, 2027. The law funds start‑up costs in FY 2026–27: $192,824 total, including $44,264 from the state and $146,951 federal.

Private plans must cover HIV prevention drugs

Health insurers must cover HIV prevention drugs, including those prescribed, dispensed, or given by a pharmacist. If several FDA‑approved drugs use the same method (like pill or shot), a plan must cover at least one per method at no out‑of‑pocket cost. Drugs with an A or B rating from the U.S. Preventive Services Task Force are covered with no out‑of‑pocket cost. Plans may not use prior authorization or step therapy for these top‑rated drugs. Plans can limit coverage to at least one drug per method, and if they use prior authorization or step therapy for a specific drug and you qualify, that drug must still be covered with no out‑of‑pocket cost.

Quick pharmacy access to HIV prevention

Pharmacies can give a 30‑ to 60‑day oral supply of PrEP, or one injection, without a prior prescription. You must have a documented negative HIV test in the past 7 days (or a pharmacist‑ordered test), no signs of acute HIV, and no conflicting medicines. The pharmacist must give CDC‑style counseling and advise you to see a primary care provider. Without a prescription, you cannot get more than a 60‑day supply or another injection from a pharmacist more than once every 2 years. The pharmacist must keep records and, with your consent, notify your primary care provider or give you a list if you do not have one or do not consent.

Pharmacy network and billing rules change

Insurers and their pharmacy benefit managers cannot stop pharmacies from prescribing, dispensing, or giving HIV prevention drugs. Insurers must let pharmacists bill directly and list the pharmacist as the provider, and cannot add training or collaboration rules beyond state law. However, plans do not have to cover PrEP or PEP from an out‑of‑network pharmacy unless your plan includes an out‑of‑network pharmacy benefit.

Sponsors & Cosponsors

Sponsor

  • Matt Moonen

    Democratic • House

Cosponsors

  • Anne-Marie Mastraccio

    Democratic • House

  • Kristi Mathieson

    Democratic • House

  • Michelle Boyer

    Democratic • House

  • Ryan Fecteau

    Democratic • House

  • Sally Cluchey

    Democratic • House

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. ACTPUB Chapter 483

    5/1/2026

  2. On motion by Senator ROTUNDO of Androscoggin taken from the Special Appropriations Table PASSED TO BE ENACTED in concurrence.

    6/25/2025Senate

  3. On motion by Senator ROTUNDO of Androscoggin PLACED ON THE SPECIAL APPROPRIATIONS TABLE pending ENACTMENT in concurrence

    6/12/2025Senate

  4. PASSED TO BE ENACTED. Sent for concurrence. ORDERED SENT FORTHWITH.

    6/11/2025House

  5. Report READ and ACCEPTED, in concurrence.READ ONCE.Committee Amendment "A" (H-642) READ and ADOPTED, in concurrence.Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED BY Committee Amendment "A" (H-642), in concurrence.Ordered sent down forthwith.

    6/11/2025Senate

  6. CONSENT CALENDAR - FIRST DAYUnder suspension of the rules CONSENT CALENDAR - SECOND DAY.The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment "A" (H-642).Sent for concurrence. ORDERED SENT FORTHWITH.

    6/11/2025House

  7. The Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES in concurrence

    4/17/2025Senate

  8. Committee on Health Coverage, Insurance and Financial Services suggested and ordered printed. The Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES.Sent for concurrence. ORDERED SENT FORTHWITH.

    4/17/2025House

Bill Text

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