In committee
PrEP Access and Coverage Act of 2026
Starting in January 2027, this bill requires private health plans, Medicare, Medicaid, and military and veterans' health programs to cover HIV prevention drugs, associated lab tests, and doctor visits with zero out-of-pocket costs and no prior authorization requirements. It also prohibits life, disability, and long-term care insurers from denying coverage or charging higher premiums to people who use HIV prevention medicine. Additionally, the measure creates grant programs to expand access for uninsured individuals, updates privacy rules so family members on shared plans are not notified of care, and allows patients to sue insurers that fail to comply.
People affected—Not determinable from the text provided; the bill applies nationwide across multiple major public and private health coverage systems and insurance markets without specifying a beneficiary count.
Fiscal magnitude—no CBO estimate published
Reach76provisional · pending reviewrigor: heuristic llm
What this bill touches.
Market protections+50Veterans' care delivery+35Government role in coverage+55Courts & liability+50Personal data & privacy+35Religious exemptions+60
Who it helps · who it burdens.
Who it helps
- Individuals seeking or using HIV prevention medications and servicesGain coverage for FDA-approved HIV prevention drugs, lab tests, and clinical monitoring without out-of-pocket costs across private insurance, Medicare, Medicaid, CHIP, TRICARE, VA, and Indian Health Service programs (Sec. 3), and gain protections against discrimination in life, disability, and long-term care insurance (Sec. 4).
- Dependents on family health insurance plansGain privacy protections enabling them to receive HIV prevention services on a family insurance policy without the primary policyholder being notified (Sec. 6).
- Community health clinics and tribal healthcare entitiesEligible to receive federal grants to fund HIV pre-exposure (PrEP) and post-exposure (PEP) programs, clinical care, adherence counseling, and outreach to uninsured or underinsured people (Sec. 7).
Who it burdens
- Private health insurers and group health plansMust cover FDA-approved HIV prevention medications, diagnostic testing, and clinical monitoring with zero cost-sharing, are restricted from imposing prior authorization, and must submit annual compliance data to federal regulators for 10 years (Sec. 3(a), Sec. 10(b)).
- Life, disability, and long-term care insurersBarred from denying or limiting coverage, raising premiums, or canceling policies based on whether an applicant or policyholder takes medication to prevent HIV (Sec. 4).
- State Medicaid and CHIP programsRequired to provide coverage for HIV prevention medications, lab tests, and clinical monitoring without cost-sharing for beneficiaries (Sec. 3(c)–(d)).
Who opposes it
- Entities seeking religious exemptions under the Religious Freedom Restoration ActThe operative text explicitly establishes that the coverage requirements apply notwithstanding the Religious Freedom Restoration Act (Public Law 103-141), foreclosing religious exemption claims under that statute (Sec. 8).