PrEP and PEP are Prevention Act

Bill Number

H.R. 5127

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-09-04: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2026-07-01T08:09:23Z

AI-Generated Summary

Purpose This legislation aims to require no-cost coverage for specific HIV prevention services, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), across private insurance, Medicare, Medicaid, CHIP, and federal employee health plans. It seeks to remove financial barriers to these services to support broader access to HIV prevention.

Key Provisions

• Mandates coverage without cost-sharing or deductibles for FDA-approved HIV prevention drugs, related administrative fees, laboratory tests, counseling (including risk assessment and medication adherence), and clinical follow-up services aligned with U.S. Public Health Service guidelines.
• Prohibits preauthorization requirements for these services in private plans, with limited exceptions for certain drugs when equivalent alternatives are available without restrictions.
• Applies these requirements to:
• Private health insurance under the Public Health Service Act.
• Medicare Part B (adding coverage and eliminating coinsurance and deductibles) and Part D (eliminating cost-sharing for qualifying drugs).
• Medicaid and CHIP (adding mandatory coverage with no cost-sharing).
• Federal Employees Health Benefits Program plans.
• Sets effective dates generally as the first plan year or January 1 after enactment, with a delay option for states needing legislation to implement Medicaid/CHIP changes.

Significant Changes to Existing Law

• Expands the list of required preventive services under Section 2713 of the Public Health Service Act to explicitly include HIV prevention services.
• Adds a new definition and coverage category for HIV prevention services in Medicare statutes, overriding standard cost-sharing rules.
• Modifies Medicaid and CHIP provisions to require inclusion of these services in state plans and benchmark coverage, with explicit no-cost-sharing protections.
• Updates title 5 of the U.S. Code to require federal employee plans to cover the services without cost-sharing.
• Introduces targeted exceptions and conforming amendments to existing cost-sharing and deductible rules in Medicare and Medicaid.

Potential Impacts

• On government agencies: Requires the Department of Health and Human Services and Centers for Medicare & Medicaid Services to oversee implementation and compliance; states may incur administrative costs or need new laws for Medicaid/CHIP alignment.
• On citizens: Expands access to HIV prevention for insured populations, potentially lowering out-of-pocket costs and supporting reduced transmission rates.
• On international relations: No direct effects identified in the legislation.

Main Stakeholders Affected

• Individuals at risk of HIV infection who are covered by the specified insurance programs.
• Private health insurers, Medicare Advantage and Part D plans, state Medicaid agencies, and federal employee health plans.
• Healthcare providers delivering counseling, testing, and monitoring services.
• Pharmaceutical manufacturers of approved HIV prevention drugs.
• Advocacy organizations focused on HIV prevention and public health.

Notable Legal, Constitutional, or Political Implications

• Strengthens federal mandates on preventive coverage in multiple insurance programs, potentially interacting with existing rules under the Affordable Care Act and Social Security Act.
• Includes provisions allowing states flexibility if legislation is needed, avoiding immediate noncompliance penalties.
• No explicit constitutional challenges or preemption issues are addressed in the text.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Waters, Maxine [D-CA-43]

Cosponsors (35)

Rep. Garcia, Robert [D-CA-42], Rep. Nadler, Jerrold [D-NY-12], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Thompson, Bennie G. [D-MS-2], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Garcia, Sylvia R. [D-TX-29], Rep. Velázquez, Nydia M. [D-NY-7], Rep. Sewell, Terri A. [D-AL-7], Rep. Carson, André [D-IN-7], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Titus, Dina [D-NV-1], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. McIver, LaMonica [D-NJ-10], Rep. Beatty, Joyce [D-OH-3], Rep. Cleaver, Emanuel [D-MO-5], Rep. Cohen, Steve [D-TN-9], Rep. Wilson, Frederica S. [D-FL-24], Rep. Simon, Lateefah [D-CA-12], Rep. Thanedar, Shri [D-MI-13], Rep. Mullin, Kevin [D-CA-15], Rep. Ramirez, Delia C. [D-IL-3], Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Tlaib, Rashida [D-MI-12], Rep. Clarke, Yvette D. [D-NY-9], Rep. Williams, Nikema [D-GA-5], Rep. Latimer, George [D-NY-16], Rep. Moore, Gwen [D-WI-4], Rep. Randall, Emily [D-WA-6], Rep. Figures, Shomari [D-AL-2], Rep. Ross, Deborah K. [D-NC-2], Rep. Pocan, Mark [D-WI-2], Rep. Johnson, Julie [D-TX-32], Rep. Kelly, Robin L. [D-IL-2], Rep. Quigley, Mike [D-IL-5]

Recent Actions

• 2025-09-04: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-09-04: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-09-04: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-09-04: Introduced in House
• 2025-09-04: Introduced in House

Bill Versions

• PrEP and PEP are Prevention Act — issued 2025-09-04 — PDF (15 pages)