PrEP Access Act

Bill Number

H.R. 7189

Origin Chamber

House

Congress

119th Congress, Session 2

Policy Area

Health

Status

Introduced

Latest Action

2026-01-21: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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

2026-04-10T08:05:58Z

AI-Generated Summary

Purpose

The PrEP Access Act (H.R. 7189) aims to expand Medicare coverage under Part B to include specific HIV prevention services provided by licensed pharmacists. This would make preventive care for HIV more accessible, particularly through pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), by allowing pharmacists to deliver these services directly, similar to how physicians currently do.

Key Provisions

• Coverage Expansion: Medicare Part B will cover "pharmacist-provided HIV prevention services," defined as services and supplies related to HIV prevention that a pharmacist is legally authorized to provide under state law. These include:
• Evaluation, management, screening, consultation, and counseling for PrEP, PEP, or other evidence-based HIV prevention methods.
• Medication administration for these interventions.
• Clinical diagnostic laboratory tests linked to these interventions.
• Payment Structure: Medicare will pay 80% of the lesser of the actual charge for the service or 85% of the standard physician fee schedule amount (under Section 1848 of the Social Security Act).
• Balance Billing Prohibition: Pharmacists providing these services cannot charge Medicare beneficiaries more than the approved amount, protecting patients from extra out-of-pocket costs.
• Effective Date: Coverage applies to services furnished on or after January 1, 2027.
• Reasonable and Necessary Requirement: Services must be deemed reasonable and necessary for HIV prevention or detection to qualify for coverage.

Significant Changes to Existing Law

• Amends Section 1861 of the Social Security Act to add pharmacist-provided HIV prevention services as a new covered benefit under Medicare Part B, treating them equivalently to services provided by physicians (with adjusted payment rates).
• Updates payment rules in Section 1833 to include these services with a specific reimbursement formula (80% of 85% of the physician rate), differing from standard physician payments.
• Modifies Section 1842 to extend balance billing protections (limits on extra charges to patients) to pharmacists for these services.
• Adds an exclusion in Section 1862 to deny coverage for services that are not reasonable and necessary for HIV prevention, aligning with existing Medicare standards but tailored to this context.

These changes mark the first explicit inclusion of pharmacists as direct providers for preventive services under Medicare Part B, beyond their traditional role in dispensing medications.

Potential Impacts

• On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to implement new billing codes, oversight for state-authorized pharmacists, and payment systems, potentially increasing administrative workload but reducing overall healthcare costs by promoting preventive care over treatment.
• On Citizens: Medicare beneficiaries, especially older adults or those at higher HIV risk (e.g., in communities with limited physician access), will gain easier access to HIV prevention without needing a doctor's visit, lowering barriers and out-of-pocket expenses. This could reduce HIV transmission rates among this population.
• On International Relations: Minimal direct impact, though it may indirectly support U.S. global health efforts by strengthening domestic HIV prevention models that could inform international aid programs.

Main Stakeholders Affected

• Medicare Beneficiaries: Primarily those eligible for Part B (individuals aged 65+ or with certain disabilities), particularly in rural or underserved areas where pharmacists are more accessible than physicians.
• Pharmacists and Pharmacies: Gains new reimbursement opportunities under Medicare, encouraging more to offer HIV prevention services, but requires state licensure compliance.
• Physicians and Healthcare Providers: May see reduced demand for routine HIV prevention consultations, potentially shifting workload, but could foster collaboration with pharmacists.
• Government Entities: CMS for administration; state governments for enforcing pharmacist authorization laws; Congress for funding implications through Medicare expenditures.
• HIV Advocacy Groups and Communities: Benefits at-risk populations, such as LGBTQ+ individuals, by improving equity in preventive care access.

Notable Legal, Constitutional, or Political Implications

• Legal: Expands the definition of "medical and other health services" under Medicare without requiring new regulations, relying on state laws for pharmacist scope-of-practice, which could lead to variations in implementation across states and potential lawsuits over authorization disputes.
• Constitutional: Aligns with the federal government's authority to regulate interstate commerce and public health (via the Social Security Act), promoting equal protection in healthcare access without raising major equal protection concerns.
• Political: Advances health equity and preventive care priorities, potentially reducing long-term Medicare costs for HIV treatment (estimated at billions annually). It may spark debates on expanding non-physician roles in Medicare, influencing future bills on pharmacist or nurse practitioner involvement in other areas, amid ongoing discussions on healthcare workforce shortages.

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

Sponsor

Rep. Pocan, Mark [D-WI-2]

Cosponsors (16)

Rep. Beatty, Joyce [D-OH-3], Rep. Dean, Madeleine [D-PA-4], Rep. Garcia, Robert [D-CA-42], Rep. Garcia, Sylvia R. [D-TX-29], Rep. Gottheimer, Josh [D-NJ-5], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. Ramirez, Delia C. [D-IL-3], Rep. Ross, Deborah K. [D-NC-2], Rep. Torres, Ritchie [D-NY-15], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Balint, Becca [D-VT-At Large], Rep. Cohen, Steve [D-TN-9], Rep. Budzinski, Nikki [D-IL-13], Rep. Friedman, Laura [D-CA-30], Rep. Pingree, Chellie [D-ME-1]

Recent Actions

• 2026-01-21: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
• 2026-01-21: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
• 2026-01-21: Introduced in House
• 2026-01-21: Introduced in House

Bill Versions

• PrEP Access Act — issued 2026-01-21 — PDF (5 pages)