PrEP Access and Coverage Act of 2026
- Bill Number
- H.R. 7853
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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
- 2026-06-30T08:06:36Z
AI-Generated Summary
Purpose of the Legislation
The PrEP Access and Coverage Act of 2026 aims to expand access to pre-exposure prophylaxis (PrEP)—medications taken to prevent HIV infection—and related services, such as post-exposure prophylaxis (PEP), to reduce HIV transmission rates. It mandates no-cost coverage across major health programs, promotes education to reduce stigma, and prevents discrimination based on PrEP use.
Key Provisions
- Insurance Coverage Mandates:
- Requires private health plans (including grandfathered plans under the Affordable Care Act), Federal Employees Health Benefits (FEHB), Medicaid, Children's Health Insurance Program (CHIP), Medicare Parts B and D, Department of Veterans Affairs (VA) benefits, Department of Defense (DoD) TRICARE program, and Indian Health Service (IHS) to cover FDA-approved PrEP drugs, administrative fees, lab tests, diagnostic procedures, clinical monitoring, and related services recommended by U.S. Public Health Service guidelines—all without cost-sharing (e.g., no deductibles, copays, or coinsurance).
- Prohibits preauthorization requirements for these services, except for specific drugs if an equivalent alternative is available without such hurdles.
- Anti-Discrimination Measures:
- Bans life, disability, and long-term care insurers from denying coverage, raising premiums, or discriminating against individuals using PrEP for HIV prevention.
- Enforcement is handled by state insurance regulators.
- Education and Outreach:
- Directs the Secretary of Health and Human Services (HHS), through the Centers for Disease Control and Prevention (CDC) and others, to launch public and provider education campaigns on PrEP and PEP. These focus on safety, effectiveness, clinical guidelines, local access, and reducing stigma, with emphasis on underserved communities (e.g., communities of color, LGBTQ+ populations).
- Campaigns must be culturally competent and evaluated for impact on access and disparities.
- Funding and Grants:
- Authorizes grants to states, territories, Indian Tribes, and eligible nonprofits (e.g., community health centers, family planning organizations) to support PrEP/PEP programs, including drugs, outreach, education, and adherence counseling for uninsured/underinsured individuals.
- Authorizes appropriations as needed for fiscal years 2026–2030; requires annual reports to Congress on grant impacts.
- Confidentiality and Enforcement:
- Amends HIPAA regulations to allow confidential access to PrEP benefits under family plans without notifying other enrollees.
- Creates a private right of action for individuals to sue for violations, including attorney fees for prevailing plaintiffs.
- Requires HHS, Labor, and Treasury to issue guidance, monitor compliance (via annual insurer reports), and enforce through audits and penalties; joint biennial reports to Congress on noncompliance.
- Effective Dates:
- Most provisions apply to plan years starting January 1, 2027; Medicaid/CHIP allows state legislative delays.
Significant Changes to Existing Law
- Affordable Care Act (ACA) and Preventive Services: Adds PrEP services to the list of essential preventive benefits under the Public Health Service Act (PHSA), Employee Retirement Income Security Act (ERISA), and Internal Revenue Code (IRC), making them the fifth such no-cost category (after items like mammograms and immunizations). Clarifies that certain 2009 breast cancer screening guidelines remain current.
- Medicaid/CHIP/Social Security Act: Explicitly includes PrEP as a covered service without cost-sharing, integrating it into benchmark plans and exempting it from deductibles.
- Medicare: Expands Part B to cover PrEP services at 100% (no coinsurance/deductible) and Part D to eliminate cost-sharing for preventive HIV drugs.
- VA/DoD/IHS: Adds PrEP to no-copay preventive services; creates new TRICARE coverage section; authorizes IHS funding for PrEP without limits.
- New Prohibitions: Introduces bans on preauthorization (via new PHSA/ERISA/IRC sections) and insurance discrimination (not previously addressed for PrEP); overrides conflicting laws like the Religious Freedom Restoration Act if needed.
- HIPAA and Public Health Service Act: Enhances privacy protections and adds education/grant programs under Part P.
Potential Impacts
- On Citizens: Improves affordability and access to HIV prevention for at-risk groups, potentially lowering new infections and healthcare costs long-term. Reduces barriers like stigma and out-of-pocket expenses, especially for uninsured/underinsured and high-risk communities, while protecting privacy in family plans.
- On Government Agencies: Increases administrative burdens for HHS (guidance, campaigns, grants), CDC (outreach/evaluation), VA/DoD/IHS (expanded benefits), and Labor/Treasury (compliance monitoring). May raise federal spending on grants and Medicare/Medicaid but could offset via fewer HIV treatments.
- On International Relations: No direct impacts; focuses on domestic U.S. health policy.
Main Stakeholders Affected
- Individuals and Communities: People at high HIV risk (e.g., LGBTQ+ individuals, communities of color, uninsured/underinsured); benefits from easier access and anti-stigma efforts.
- Healthcare Providers and Organizations: Doctors, clinics, Federally Qualified Health Centers, family planning grantees, and nonprofits gain resources for PrEP/PEP delivery and education.
- Insurers and Employers: Private insurers, group health plans, and life/disability insurers must comply with no-cost coverage and anti-discrimination rules, potentially increasing short-term costs.
- Government Entities: HHS, CDC, states/territories/Tribes (for grants and Medicaid/CHIP implementation), VA, DoD, and state insurance regulators face new oversight and funding responsibilities.
- Nonprofits and Advocates: Community-based organizations and HIV-focused groups can apply for grants and collaborate on campaigns.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens preventive care mandates under the ACA, potentially leading to litigation over preauthorization bans or discrimination prohibitions if insurers challenge them as overreaching. Private right of action empowers individuals but may increase court cases; state enforcement varies by local laws.
- Constitutional: No major issues anticipated; aligns with Congress's authority over interstate commerce and spending for public health. Clarification overriding religious exemptions (e.g., via Section 8) could invite First Amendment challenges from faith-based insurers.
- Political: Promotes health equity by targeting disparities in HIV-affected communities, likely supported by public health advocates but opposed by some over mandates on insurers or federal costs. Biennial compliance reports enhance transparency and accountability.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (31)
Rep. Pocan, Mark [D-WI-2], Rep. Balint, Becca [D-VT-At Large], Rep. Mullin, Kevin [D-CA-15], Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Scanlon, Mary Gay [D-PA-5], Rep. DelBene, Suzan K. [D-WA-1], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Moskowitz, Jared [D-FL-23], Rep. Quigley, Mike [D-IL-5], Rep. Bonamici, Suzanne [D-OR-1], Rep. Velázquez, Nydia M. [D-NY-7], Rep. Stanton, Greg [D-AZ-4], Rep. Moulton, Seth [D-MA-6], Rep. Torres, Norma J. [D-CA-35], Rep. Casten, Sean [D-IL-6], Rep. Dingell, Debbie [D-MI-6], Rep. García, Jesús G. "Chuy" [D-IL-4], Rep. Sewell, Terri A. [D-AL-7], Rep. Carson, André [D-IN-7], Rep. Wasserman Schultz, Debbie [D-FL-25], Rep. Hayes, Jahana [D-CT-5], Rep. Davids, Sharice [D-KS-3], Rep. Dean, Madeleine [D-PA-4], Rep. Titus, Dina [D-NV-1], Rep. Lieu, Ted [D-CA-36], Rep. Pingree, Chellie [D-ME-1], Rep. Garcia, Robert [D-CA-42], Rep. Cohen, Steve [D-TN-9], Rep. Fletcher, Lizzie [D-TX-7], Rep. Matsui, Doris O. [D-CA-7], Rep. Pappas, Chris [D-NH-1]
Recent Actions
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural Resources, Financial Services, and Education and Workforce, 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.
- 2026-03-05: Introduced in House
- 2026-03-05: Introduced in House
Bill Versions
- PrEP Access and Coverage Act of 2026 — issued 2026-03-05 — PDF (35 pages)