,,ii  #aahth ,,congress  #ast ,session  
,s4 #bahh  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #bb1     
#bjbc,ms4 ,smith introduced the         
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to increase access to          
pre-exposure prophylaxis to reduce the  
transmission of ,,hiv4  #a4 ,short title
 ,this ,act may be cited as the ,pr,e,p 
,access and ,coverage ,act of #bjbc4    
#b4 ,findings2 sense of ,congress  7a7  
,findings ,congress finds the following3
 7#a7 ,the ,centers for ,disease        
,control and ,prevention estimates that 
approximately #a1bjj1jjj individuals in 
the ,united ,states are living with     
,,hiv4  7#b7 ,in #bjba1 there were      
#cf1acf new diagnoses of ,,hiv in the   
,united ,states4  7#c7 ,,hiv            
disproportionately impacts gay and      
bisexual men1 transgender women1 and1 in
 particular1 people of color4 ,in #bjba1
 approximately #ga percent of new ,,hiv 

diagnoses were estimated to be among gay
 and bisexual men1 #dj percent of new   
,,hiv diagnoses were among ,black       
people1 and #bi percent of new ,,hiv    
diagnoses were among ,latinx people4    
,recent studies suggest that transgender
 women are up to #di times more likely  
to be diagnosed with ,,hiv than the     
general population4 ,members of         
communities at the intersections of     
these groups are most heavily impacted4 
7#d7 ,pre-exposure prophylaxis 7referred
 to in this section as ,pr,e,p7 is a    
daily antiretroviral medication that    
helps prevent individuals from acquiring
 ,,hiv4 ,daily ,pr,e,p use reduces the  
risk of getting ,,hiv from sex by more  
than #ii percent4 ,it reduces the risk  
of getting ,,hiv from injection drug use
 by at least #gd percent4  7#e7 ,many   
individuals at risk of exposure to ,,hiv
 do not use ,pr,e,p4 ,of the            
approximately #a1bjj1jjj individuals in 
the ,united ,states who could benefit   
from ,pr,e,p1 only #ca percent1 or      

#chb1cfd individuals1 filled            
prescriptions for the drug in #bjbb4    
7#f7 ,pr,e,p usage is inconsistent      
across racial and gender lines4 ,in     
#bjbb1 only #aa percent of              
,black_/,african ,american and #ba      
percent of ,hispanic_/,latinx           
individuals who were eligible for       
,pr,e,p were prescribed it1 compared to 
#hb percent of eligible ,white          
individuals4 ,pr,e,p usage is low among 
women1 in particular among heterosexual 
women of color4 ,slightly less than #ab 
percent of women eligible for ,pr,e,p   
received a prescription in #bjbb4  7#g7 
,pr,e,p use helps strengthen families by
 allowing couples with partners of      
different ,,hiv statuses to prevent the 
transmission of ,,hiv4  7#h7 ,there are 
currently #b brand name drugs and #a    
generic drug approved by the ,food and  
,drug ,administration for the use of    
,pr,e,p on a daily basis4 ,a long-acting
 injectable ,pr,e,p drug has also been  
approved by the ,food and ,drug         

,administration4 ,other types of ,,hiv  
prevention treatments1 including other  
long-acting injectables1 long-acting    
oral pills1 implants1 and vaginal rings 
are in the research pipeline4 ,these    
innovations can increase widespread use 
of ,pr,e,p along with adherence1 which  
can speed the ,nation's goal to end     
,,hiv and address inequities in health  
care4  7#i7 ,section #bgac of the       
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg-#ac7 requires         
non-grandfathered private health        
insurance plans to cover preventive     
services without cost-sharing1 including
 such services with a rating of ,a or ,b
 under recommendations of the ,united   
,states ,preventive ,services ,task     
,force4 ,on ,june #aa1 #bjai1 the       
,united ,states ,preventive ,services   
,task ,force issued a final             
recommendation giving an ,a grade for   
,pr,e,p for individuals at high risk of 
,,hiv2 non-grandfathered private health 
insurance plans have to cover ,pr,e,p   

for such individuals without            
cost-sharing effective ,january #bjba4  
,updated ,united ,states ,preventive    
,service ,task ,force guidance          
incorporating the new long-acting       
injectable ,pr,e,p drug is pending4     
7#aj7 ,joint guidance issued by the     
,department of ,labor1 the ,department  
of ,health and ,human ,services1 and the
 ,department of the ,treasury on ,july  
#ai1 #bjba1 clarifies that ancillary    
services necessary to maintain the      
,pr,e,p regime1 including subsequent    
provider visits1 clinical testing1 and  
other services1 is required to be       
covered by health insurers without      
cost-sharing4  7#aa7 ,permanently       
expanding access to cost-free ,pr,e,p   
and ancillary services for all          
individuals1 including individuals who  
do not have health insurance1 through   
legislation1 is a critical step towards 
eliminating ,,hiv transmission4  7#ab7  
,post-exposure prophylaxis 7referred to 
in this section as ,,pep7 is a daily    

antiretroviral treatment which1 when    
initiated promptly after a sexual or    
other exposure to blood or body fluids  
that are associated with a high risk of 
,,hiv transmission1 is highly effective 
at preventing ,,hiv transmission4  7#ac7
 ,the ,centers for ,disease ,control and
 ,prevention recommends ,,pep for an    
individual who has experienced a        
high-risk exposure incident1 provided   
that the individual tests               
,,hiv-negative1 initiates such treatment
 not later than #gb hours after         
exposure1 and continues the treatment   
for #bh days4  7#ad7 ,despite ,,pep's   
proven effectiveness in preventing ,,hiv
 transmission after high-risk sexual    
exposures1 including sexual assault1    
awareness of ,,pep is low among         
individuals who would benefit from the  
treatment4 ,studies suggest that        
awareness of ,,pep and of the importance
 of its prompt initiation is            
particularly low among young gay and    
bisexual men of color1 transgender      

individuals1 and women of all gender    
identities4  7#ae7 ,adequate knowledge  
of guidelines issued by the ,centers for
 ,disease ,control and ,prevention for  
assessing indications for ,,pep and for 
initiating and sustaining ,,pep are low 
among health care providers and staff4  
,because ,,pep is an emergency          
intervention1 insufficient knowledge    
among providers and staff in hospital   
emergency rooms1 urgent care centers1   
community health centers1 and primary   
care physicians is of particular        
concern4  7#af7 ,private and public     
health insurance plans and programs     
frequently impose requirements for      
coverage of ,,pep1 including            
pre-authorization requirements and      
requirements to obtain the medications  
through designated specialty pharmacies 
and mail-order programs that pose       
significant obstacles to timely         
initiation of treatment4  7#ag7         
,insurance deductibles and co-payments  
for ,,pep medications create significant

 barriers to ,,pep utilization by many  
individuals who have experienced        
high-risk incidents4  7#ah7 ,the        
,federal ,government has a compelling   
interest in preventing new cases of     
,,hiv4 ,lowering the prevalence of ,,hiv
 protects public health and saves on the
 cost of ,,hiv treatment4  7b7 ,sense of
 ,congress ,it is the sense of ,congress
 that the ,department of ,labor1 the    
,department of ,health and ,human       
,services1 and the ,department of the   
,treasury should ensure compliance with 
the requirements described in paragraphs
 7#i7 and 7#aj7 of subsection 7a74  #c4 
,coverage of ,,hiv testing and          
prevention services  7a7 ,private       
insurance  7#a7 ,in general ,section    
#bgac7;a7 of the ,public ,health        
,service ,act 7#db ,u4,s4,c4            
#cjj;gg-#ac7;a77 is amended-- 7,a7 in   
paragraph 7#b71 by striking 2 and and   
inserting a semicolon2  7,b7 in         
paragraph 7#c71 by striking the period  
and inserting a semicolon2  7,c7 in     

paragraph 7#d71 by striking the period  
and inserting a semicolon2  7,d7 in     
paragraph 7#e71 by striking the period  
and inserting 2 and2 and  7,e7 by adding
 at the end the following3  7#f7 any    
prescription drug approved by the ,food 
and ,drug ,administration for the       
prevention of ,,hiv 7other than a drug  
subject to preauthorization requirements
 consistent with section #bgbi;,a71     
administrative fees for such drugs1     
laboratory and other diagnostic         
procedures associated with the use of   
such drugs1 and clinical follow-up and  
monitoring1 including any related       
services recommended in current ,united 
,states ,public ,health ,service        
clinical practice guidelines1 without   
limitation4  4  7#b7 ,prohibition on    
preauthorization requirements ,subpart  
,,ii of part ,a of title ,,xxvii of the 
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg-#aa et seq47 is       
amended by adding at the end the        
following3  #bgbi;,a4 ,prohibition on   

preauthorization requirements with      
respect to certain services ,a group    
health plan or a health insurance issuer
 offering group or individual health    
insurance coverage shall not impose any 
preauthorization requirements with      
respect to coverage of the services     
described in section #bgac7;a77#f71     
except that a plan or issuer may impose 
preauthorization requirements with      
respect to coverage of a particular drug
 approved under section #eje7;c7 of the 
,federal ,food1 ,drug1 and ,cosmetic    
,act or section #cea7;a7 of this ,act if
 such plan or issuer provides coverage  
without any preauthorization            
requirements for a drug that is         
therapeutically equivalent4  4  7b7     
,coverage under ,federal ,employees     
,health ,benefits program ,section #hijd
 of title #e1 ,united ,states ,code1 is 
amended by adding at the end the        
following3  7c7 ,any health benefits    
plan offered under this chapter shall   
include benefits for1 and may not impose

 any cost-sharing requirements for1 any 
prescription drug approved by the ,food 
and ,drug ,administration for the       
prevention of ,,hiv1 administrative fees
 for such drugs1 laboratory and other   
diagnostic procedures associated with   
the use of such drugs1 and clinical     
follow-up and monitoring1 including any 
related services recommended in current 
,united ,states ,public ,health ,service
 clinical practice guidelines1 without  
limitation4  4  7c7 ,medicaid  7#a7 ,in 
general ,section #aije of the ,social   
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is amended-- 7,a7 in subsection         
7a77#d7-- 7i7 by striking 2 and 7,d7 and
 inserting 2 7,d72  7ii7 by striking 2  
and 7,e7 and inserting 2 7,e72  7iii7 by
 striking 2 and 7,f7 and inserting 2    
7,f72 and  7iv7 by striking the         
semicolon at the end and inserting 2 and
 7,g7 ,,hiv prevention services22 and   
7,b7 by adding at the end the following 
new subsection3  7jj7 ,,hiv prevention  
services ,for purposes of subsection    

7a77#d77;,g71 the term ,,hiv prevention 
services means prescription drugs for   
the prevention of ,,hiv acquisition1    
administrative fees for such drugs1     
laboratory and other diagnostic         
procedures associated with the use of   
such drugs1 and clinical follow-up and  
monitoring1 including any related       
services recommended in current ,united 
,states ,public ,health ,service        
clinical practice guidelines1 without   
limitation4  4  7#b7 ,no cost-sharing   
,title ,,xix of the ,social ,security   
,act 7#db ,u4,s4,c4 #acif et seq47 is   
amended-- 7,a7 in section #aiaf1 by     
inserting ,,hiv prevention services     
described in section #aije7;a77#d77;,g71
 after section #aije7;a77#d77;,c71 each 
place it appears2 and  7,b7 in section  
#aiaf;,a7b77#c77;,b71 by adding at the  
end the following new clause3  7xv7     
,,hiv prevention services described in  
section #aije7;a77#d77;,g74  4  7#c7    
,inclusion in benchmark coverage        
,section #aicg7;b77#g7 of the ,social   

,security ,act 7#db ,u4,s4,c4           
#acifu-#g7;b77#g77 is amended-- 7,a7 in 
the paragraph header1 by inserting and  
,,hiv prevention services after         
supplies2 and  7,b7 by striking includes
 for any individual described in section
 #aije7;a77#d77;,c71 medical assistance 
for family planning services and        
supplies in accordance with such section
 and inserting includes medical         
assistance for ,,hiv prevention services
 described in section                   
#aije7;a77#d77;,g71 and includes1 for   
any individual described in section     
#aije7;a77#d77;,c71 medical assistance  
for family planning services and        
supplies in accordance with such        
section4  7d7 ,,chip  7#a7 ,in general  
,section #bajc of the ,social ,security 
,act 7#db ,u4,s4,c4 #acig;cc71 as       
amended by section #aadje7;b77#a7 of    
,public ,law #aag-afi1 is amended-- 7,a7
 in subsection 7a71 by striking and 7#h7
 and inserting 7#h71 7#aj71 7#aa71 and  
7#ac72 and  7,b7 in subsection 7c71 by  

adding at the end the following new     
paragraph3  7#ac7 ,,hiv prevention      
services ,regardless of the type of     
coverage elected by a ,state under      
subsection 7a71 the child health        
assistance provided for a targeted      
low-income child1 and1 in the case of a 
,state that elects to provide           
pregnancy-related assistance pursuant to
 section #baab1 the pregnancy-related   
assistance provided for a targeted      
low-income pregnant woman 7as such terms
 are defined for purposes of such       
section71 shall include coverage of     
,,hiv prevention services 7as defined in
 section #aije7;jj774  4  7#b7 ,no      
cost-sharing ,section #bajc7;e77#b7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acig;cc7e77#b77 is amended by
 inserting ,,hiv prevention services    
described in subsection 7c77#ac71 before
 or for pregnancy-related assistance4   
7#c7 ,effective date  7,a7 ,in general  
,subject to subparagraph 7,b71 the      
amendments made by subsection 7c7 and   

this subsection shall take effect on    
,january #a1 #bjbe4  7,b7 ,delay        
permitted if ,state legislation required
 ,in the case of a ,state plan approved 
under title ,,xix or ,,xxi of the       
,social ,security ,act which the        
,secretary of ,health and ,human        
,services determines requires ,state    
legislation 7other than legislation     
appropriating funds7 in order for the   
plan to meet the additional requirements
 imposed by this section1 the ,state    
plan shall not be regarded as failing to
 comply with the requirements of such   
title solely on the basis of the failure
 of the plan to meet such additional    
requirements before the #ast day of the 
#ast calendar quarter beginning after   
the close of the #ast regular session of
 the ,state legislature that ends after 
the #a-year period beginning with the   
date of the enactment of this section4  
,for purposes of the preceding sentence1
 in the case of a ,state that has a     
#b-year legislative session1 each year  

of the session is deemed to be a        
separate regular session of the ,state  
legislature4  7e7 ,coverage and         
elimination of cost-,sharing under      
,medicare  7#a7 ,coverage of ,,hiv      
prevention services under ,part ,b  7,a7
 ,coverage  7i7 ,in general ,section    
#ahfa7s77#b7 of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciex7s77#b77 is   
amended-- 7,i7 in subparagraph 7,,ii71  
by striking and at the end2  7,,ii7 in  
subparagraph 7,,jj71 by inserting and at
 the end2 and  7,,iii7 by adding at the 
end the following new subparagraph3     
7,,kk7 ,,hiv prevention services 7as    
defined in subsection 7nnn772  4  7ii7  
,definition ,section #ahfa of the       
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7 is amended by adding at the end 
the following new subsection3  7nnn7    
,,hiv prevention services ,the term     
,,hiv prevention services means-- 7#a7  
drugs or biologicals approved by the    
,food and ,drug ,administration for the 
prevention of ,,hiv2  7#b7              

administrative fees for such drugs2     
7#c7 laboratory and other diagnostic    
procedures associated with the use of   
such drugs2 and  7#d7 clinical follow-up
 and monitoring1 including any related  
services recommended in current ,united 
,states ,public ,health ,service        
clinical practice guidelines1 without   
limitation4  4  7,b7 ,elimination of    
coinsurance ,section #ahcc7;a77#a7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciel7a77#a77 is amended--   
7i7 by striking and 7,,hh7 and inserting
 7,,hh72 and  7ii7 by inserting before  
the semicolon at the end the following3 
1 and 7,,ii7 with respect to ,,hiv      
prevention services 7as defined in      
section #ahfa7nnn771 the amount paid    
shall be #ajj percent of 7i7 except as  
provided in clause 7ii71 the lesser of  
the actual charge for the service or the
 amount determined under the fee        
schedule that applies to such services  
under this part1 and 7ii7 in the case of
 such services that are covered ,,opd   

services 7as defined in subsection      
7t77#a77;,b771 the amount determined    
under subsection 7t74  7,c7 ,exemption  
from ,part ,b deductible ,the first     
sentence of section #ahcc7;b7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7b77 is amended-- 7i7 by striking 
1 and 7#ac7 and inserting 7#ac72 and    
7ii7 by striking #ahfa7n744 and         
inserting #ahfa7n71 and 7#ad7 such      
deductible shall not apply with respect 
to ,,hiv prevention services 7as defined
 in section #ahfa7nnn77#a7744  7,d7     
,effective date ,the amendments made by 
this paragraph shall apply to items and 
services furnished on or after ,january 
#a1 #bjbe4  7#b7 ,elimination of        
cost-sharing for drugs for the          
prevention of ,,hiv under part ,d  7,a7 
,in general ,section #ahfj;,d-#b of the 
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajb7;b77 is amended-- 7i7 in    
subsection 7b7-- 7,i7 in paragraph      
7#a77;,a71 by striking and 7#i7 and     
inserting 1 7#i71 and 7#aj72  7,,ii7 in 

paragraph 7#b7-- 7aa7 in subparagraph   
7,a71 by striking and 7#i7 and inserting
 1 7#i71 and 7#aj72  7bb7 in            
subparagraph 7,c77i71 in the matter     
preceding subclause 7,i71 by striking   
and 7#i7 and inserting 7#i71 and 7#aj72 
and  7cc7 in subparagraph 7,d77i71 in   
the matter preceding subclause 7,i71 by 
striking and 7#i7 and inserting 7#i71   
and 7#aj72  7,,iii7 in paragraph        
7#c77;,a71 in the matter preceding      
clause 7i71 by striking and 7#i7 and    
inserting 7#i71 and 7#aj72  7,,iv7 in   
paragraph 7#d77;,a77i71 by striking and 
7#i7 and inserting 1 7#i71 and 7#aj72   
and  7,v7 by adding at the end the      
following new paragraph3  7#aj7         
,elimination of cost-sharing for drugs  
for the prevention of ,,hiv ,for plan   
years beginning on or after ,january #a1
 #bjbe1 with respect to a covered part  
,d drug that is for the prevention of   
,,hiv-- 7,a7 the deductible under       
paragraph 7#a7 shall not apply2 and     
7,b7 there shall be no coinsurance or   

other cost-sharing under this part with 
respect to such drug4  2 and  7ii7 in   
subsection 7c71 by adding at the end the
 following new paragraph3  7#g7         
,treatment of cost-sharing for drugs for
 the prevention of ,,hiv ,the coverage  
is provided in accordance with          
subsection 7b77#aj74  4  7,b7           
,conforming amendments to cost-sharing  
for low-income individuals ,section     
#ahfj;,d-#ad7;a7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77 is amended-- 7i7 in    
paragraph 7#a77;,d71 in each of clauses 
7ii7 and 7iii71 by striking paragraph   
7#f7 and inserting paragraphs 7#f7 and  
7#g72  7ii7 in paragraph 7#b7-- 7,i7 in 
subparagraph 7,b71 by striking and 7#i7 
and inserting 1 7#i71 and 7#aj72  7,,ii7
 in subparagraph 7,d71 by striking      
paragraph 7#f7 and inserting paragraphs 
7#f7 and 7#g72 and  7,,iii7 in          
subparagraph 7,e71 by striking paragraph
 7#f7 and inserting paragraphs 7#f7 and 
7#g72 and  7iii7 by adding at the end   

the following new paragraph3  7#g7 ,no  
application of cost-sharing or          
deductible for drugs for the prevention 
of ,,hiv ,for plan years beginning on or
 after ,january #a1 #bjbe1 with respect 
to a covered part ,d drug that is for   
the prevention of ,,hiv-- 7,a7 the      
deductible under section                
#ahfj;,d-#b7;b77#a7 shall not apply2 and
  7,b7 there shall be no cost-sharing   
under this section with respect to such 
drug4  4  7f7 ,coverage of ,,hiv        
prevention treatment by ,department of  
,veterans ,affairs  7#a7 ,elimination of
 medication copayments ,section         
#agbb;,a7a7 of title #ch1 ,united       
,states ,code1 is amended by adding at  
the end the following new paragraph3    
7#e7 ,paragraph 7#a7 does not apply to a
 medication for the prevention of ,,hiv4
  4  7#b7 ,elimination of hospital care 
and medical services copayments ,section
 #agaj of such title is amended-- 7,a7  
in subsection 7f7-- 7i7 by redesignating
 paragraph 7#e7 as paragraph 7#f72 and  

7ii7 by inserting after paragraph 7#d7  
the following new paragraph 7#e73  7#e7 
,a veteran shall not be liable to the   
,united ,states under this subsection   
for any amounts for laboratory and other
 diagnostic procedures associated with  
the use of any prescription drug        
approved by the ,food and ,drug         
,administration for the prevention of   
,,hiv1 administrative fees for such     
drugs1 or for laboratory or other       
diagnostic procedures associated with   
the use of such drugs1 or clinical      
follow-up and monitoring1 including any 
related services recommended in current 
,united ,states ,public ,health ,service
 clinical practice guidelines1 without  
limitation4  2 and  7,b7 in subsection  
7g77#c71 by adding at the end the       
following new subparagraph3  7,c7 ,any  
prescription drug approved by the ,food 
and ,drug ,administration for the       
prevention of ,,hiv1 administrative fees
 for such drugs1 laboratory and other   
diagnostic procedures associated with   

the use of such drugs1 and clinical     
follow-up and monitoring1 including any 
related services recommended in current 
,united ,states ,public ,health ,service
 clinical practice guidelines1 without  
limitation4  4  7#c7 ,inclusion as      
preventive health service ,section      
#agja7i7 of such title is amended-- 7,a7
 in subparagraph 7,k71 by striking 2 and
 and inserting a semicolon2  7,b7 by    
redesignating subparagraph 7,l7 as      
subparagraph 7,m72 and  7,c7 by         
inserting after subparagraph 7,k7 the   
following new subparagraph 7,l73  7,l7  
any prescription drug approved by the   
,food and ,drug ,administration for the 
prevention of ,,hiv1 administrative fees
 for such drugs1 laboratory and other   
diagnostic procedures associated with   
the use of such drugs1 and clinical     
follow-up and monitoring1 including any 
related services recommended in current 
,united ,states ,public ,health ,service
 clinical practice guidelines1 without  
limitation2 and  4  7g7 ,coverage of    

,,hiv prevention treatment by           
,department of ,defense  7#a7 ,in       
general ,chapter #ee of title #aj1      
,united ,states ,code1 is amended by    
inserting after section #ajgdo the      
following new section3  #ajgdp4         
,coverage of ,,hiv prevention treatment 
7a7 ,in general ,the ,secretary of      
,defense shall ensure coverage under the
 ,,tricare program of ,,hiv prevention  
treatment described in subsection 7b7   
for any beneficiary under section       
#ajgd7;a7 of this title4  7b7 ,,hiv     
prevention treatment described ,,hiv    
prevention treatment described in this  
subsection includes any prescription    
drug approved by the ,food and ,drug    
,administration for the prevention of   
,,hiv1 administrative fees for such     
drugs1 laboratory and other diagnostic  
procedures associated with the use of   
such drugs1 and clinical follow-up and  
monitoring1 including any related       
services recommended in current ,united 
,states ,public ,health ,service        

clinical practice guidelines1 without   
limitation4  7c7 ,no cost-,sharing      
,notwithstanding section #ajge1 #ajge;a1
 or #ajgd;g7a77#f7 of this title or any 
other provision of law1 there is no     
cost-sharing requirement for ,,hiv      
prevention treatment covered under this 
section4  4  7#b7 ,clerical amendment   
,the table of sections at the beginning 
of such chapter is amended by inserting 
after the item relating to section      
#ajgdo the following new item3  #ajgdp4 
,coverage of ,,hiv prevention treatment4
  4  7h7 ,indian health service testing1
 monitoring1 and prescription drugs for 
the prevention of ,,hiv ,title ,,ii of  
the ,indian ,health ,care ,improvement  
,act is amended by inserting after      
section #bbc 7#be ,u4,s4,c4 #afbav7 the 
following3  #bbd4 ,testing1 monitoring1 
and prescription drugs for the          
prevention of ,,hiv  7a7 ,in general    
,the ,secretary1 acting through the     
,director of ,,hiv_/,,aids ,prevention  
and ,treatment under section #hcb1      

,indian tribes1 and tribal              
organizations1 shall provide1 without   
limitation1 funding for any prescription
 drug approved by the ,food and ,drug   
,administration for the prevention of   
human immunodeficiency virus 7commonly  
known as ,,hiv71 administrative fees for
 that drug1 laboratory and other        
diagnostic procedures associated with   
the use of that drug1 and clinical      
follow-up and monitoring1 including any 
related services recommended in current 
,united ,states ,public ,health ,service
 clinical practice guidelines4  7b7     
,authorization of appropriations ,there 
are authorized to be appropriated such  
sums as are necessary to carry out this 
section4  4  7i7 ,effective date ,the   
amendments made by subsections 7a71 7b71
 7e71 7f71 7g71 and 7h7 shall take      
effect with respect to plan years       
beginning on or after ,january #a1      
#bjbe4  #d4 ,prohibition on denial of   
coverage or increase in premiums of     
life1 disability1 or long-term care     

insurance for individuals taking        
medication for the prevention of ,,hiv  
acquisition  7a7 ,prohibition           
,notwithstanding any other provision of 
law1 it shall be unlawful to-- 7#a7     
decline or limit coverage of an         
individual under any life insurance     
policy1 disability insurance policy1 or 
long-term care insurance policy1 on     
account of the individual taking        
medication for the purpose of preventing
 the acquisition of ,,hiv2  7#b7        
preclude an individual from taking      
medication for the purpose of preventing
 the acquisition of ,,hiv as a condition
 of receiving a life insurance policy1  
disability insurance policy1 or         
long-term care insurance policy2  7#c7  
consider whether an individual is taking
 medication for the purpose of          
preventing the acquisition of ,,hiv in  
determining the premium rate for        
coverage of such individual under a life
 insurance policy1 disability insurance 
policy1 or long-term care insurance     

policy2 or  7#d7 otherwise discriminate 
in the offering1 issuance1 cancellation1
 amount of such coverage1 price1 or any 
other condition of a life insurance     
policy1 disability insurance policy1 or 
long-term care insurance policy for an  
individual1 based solely and without any
 additional actuarial risks upon whether
 the individual is taking medication for
 the purpose of preventing the          
acquisition of ,,hiv4  7b7 ,enforcement 
,a ,state insurance regulator may take  
such actions to enforce subsection 7a7  
as are specifically authorized under the
 laws of such ,state4  7c7 ,definitions 
,in this section3 7#a7 ,disability      
insurance policy ,the term disability   
insurance policy means a contract under 
which an entity promises to pay a person
 a sum of money in the event that an    
illness or injury resulting in a        
disability prevents such person from    
working4  7#b7 ,life insurance policy   
,the term life insurance policy means a 
contract under which an entity promises 

to pay a designated beneficiary a sum of
 money upon the death of the insured4   
7#c7 ,long-term care insurance policy   
,the term long-term care insurance      
policy means a contract for which the   
only insurance protection provided under
 the contract is coverage of qualified  
long-term care services 7as defined in  
section #ggjb;,b7c7 of the ,internal    
,revenue ,code of #aihf74  #e4 ,public  
education campaign ,part ,p of title    
,,iii of the ,public ,health ,service   
,act 7#db ,u4,s4,c4 #bhj;g et seq47 is  
amended by adding at the end the        
following3  #cii,v-#h4 ,pre-exposure    
prophylaxis and post-exposure           
prophylaxis education campaigns  7a7    
,public education campaign  7#a7 ,in    
general ,the ,secretary1 acting through 
the ,director of the ,centers for       
,disease ,control and ,prevention1 in   
consultation with the ,director of the  
,office of ,infectious ,disease and     
,,hiv_/,,aids ,policy1 shall establish a
 public health campaign for the purpose 

of educating the public on medication   
for the prevention of ,,hiv acquisition4
  7#b7 ,requirements ,in carrying out   
this subsection1 the ,secretary shall   
ensure cultural competency and efficacy 
within high-need communities in which   
,pr,e,p or ,,pep are underutilized by   
developing the campaign in collaboration
 with organizations that are indigenous 
to communities that are overrepresented 
in the domestic ,,hiv epidemic1         
including communities of color and the  
lesbian1 gay1 bisexual1 transgender1 and
 queer community4 ,the ,secretary shall 
ensure that the campaign is designed to 
increase awareness of the safety and    
effectiveness of ,pr,e,p and ,,pep1 the 
recommended clinical practices for      
providing ,pr,e,p-related and           
,,pep-related clinical care1 and the    
local availability of ,pr,e,p and ,,pep 
providers1 and to counter stigma        
associated with the use of ,pr,e,p and  
,,pep4  7#c7 ,evaluation of program ,the
 ,secretary shall develop measures to   

evaluate the effectiveness of activities
 conducted under this subsection that   
are aimed at reducing disparities in    
access to ,pr,e,p and ,,pep and         
supporting the local community4 ,such   
measures shall evaluate community       
outreach activities1 language services1 
workforce cultural competence1 and other
 areas as determined by the ,secretary4 
7b7 ,provider education campaign  7#a7  
,in general ,the ,secretary1 acting     
through the ,director of the ,centers   
for ,disease ,control and ,prevention1  
the ,administrator of the ,health       
,resources and ,services                
,administration1 and the ,office of     
,infectious ,disease and ,,hiv_/,,aids  
,policy1 shall establish a provider     
campaign for the purpose of educating   
prescribers and other associated health 
professionals on medication for the     
prevention of ,,hiv acquisition4  7#b7  
,requirements ,in carrying out this     
subsection1 the ,secretary shall        
increase awareness and readiness among  

health care providers to offer ,pr,e,p  
or ,,pep1 as appropriate1 with a focus  
on areas of high-need communities in    
which ,pr,e,p or ,,pep is underutilized 
by developing an educational campaign   
with input from health care providers   
and organizations that are indigenous to
 communities that are overrepresented in
 the domestic ,,hiv epidemic1 including 
communities of color and the lesbian1   
gay1 bisexual1 transgender1 and queer   
community4 ,the ,secretary shall ensure 
that the campaign is designed to        
increase awareness of the safety and    
effectiveness of ,pr,e,p and ,,pep1 the 
recommended clinical practices for      
providing ,pr,e,p-related and           
,,pep-related clinical care1 cultural   
competency among ,pr,e,p and ,,pep      
prescribers1 and to counter stigma      
associated with the use of ,pr,e,p and  
,,pep4  7#c7 ,evaluation of program ,the
 ,secretary shall develop measures to   
evaluate the effectiveness of activities
 conducted under this subsection that   

are aimed at increasing the number of   
health care professionals offering      
,pr,e,p and ,,pep and reducing          
disparities in access to ,pr,e,p and    
,,pep4 ,such measures shall evaluate    
availability of ,pr,e,p and ,,pep       
services1 education and outreach        
activities1 language services1 workforce
 cultural competence1 and other areas as
 determined by the ,secretary4  7c7     
,definitions ,in this section and       
section #cii,v-#i-- 7#a7 the term ,,pep 
means any drug or combination of drugs  
approved by the ,food and ,drug         
,administration for preventing ,,hiv    
transmission after a sexual or other    
exposure associated with a high risk of 
,,hiv transmission2 and  7#b7 the term  
,pr,e,p means any drug approved by the  
,food and ,drug ,administration for the 
purpose of pre-exposure prophylaxis with
 respect to ,,hiv4  7d7 ,authorization  
of appropriations ,to carry out this    
section1 there are authorized to be     
appropriated such sums as may be        

necessary for each of fiscal years #bjbd
 through #bjbi4  4  #f4 ,patient        
confidentiality ,the ,secretary of      
,health and ,human ,services shall amend
 the regulations promulgated under      
section #bfd7;c7 of the ,health         
,insurance ,portability and             
,accountability ,act of #aiif 7#db      
,u4,s4,c4 #acbj;d-#b note71 as          
necessary1 to ensure that individuals   
are able to access the benefits         
described in section #bgac7;a77#f7 under
 a family plan without any other        
individual enrolled in such family plan1
 including a primary subscriber of or   
policyholder1 being informed of such use
 of such benefits4  #g4 ,pre-exposure   
prophylaxis and post-exposure           
prophylaxis funding ,part ,p of title   
,,iii of the ,public ,health ,service   
,act 7#db ,u4,s4,c4 #bhj;g et seq471 as 
amended by section #e1 is further       
amended by adding at the end the        
following3  #cii,v-#i4 ,pre-exposure    
prophylaxis and post-exposure           

prophylaxis funding  7a7 ,in general    
,not later than #a year after the date  
of the enactment of the ,pr,e,p ,access 
and ,coverage ,act of #bjbc1 the        
,secretary shall establish a program    
that awards grants to ,states1          
territories1 ,indian ,tribes1 and       
directly eligible entities for the      
establishment and support of            
pre-exposure prophylaxis 7referred to in
 this section as ,pr,e,p7 and           
post-exposure prophylaxis 7referred to  
in this section as ,,pep7 programs4  7b7
 ,applications ,to be eligible to       
receive a grant under subsection 7a71 a 
,state1 territory1 ,indian ,tribe1 or   
directly eligible entity shall-- 7#a7   
submit an application to the ,secretary 
at such time1 in such manner1 and       
containing such information as the      
,secretary may require1 including a plan
 describing how any funds awarded will  
be used to increase access to ,pr,e,p   
for uninsured and underinsured          
individuals and reduce disparities in   

access to ,pr,e,p and ,,pep for         
uninsured and underinsured individuals  
and reduce disparities in access to     
,pr,e,p and ,,pep2 and  7#b7 appoint a  
,pr,e,p and ,,pep grant administrator to
 manage the program4  7c7 ,directly     
eligible entity ,for purposes of this   
section1 the term directly eligible     
entity-- 7#a7 means a ,federally        
qualified health center or other        
nonprofit entity engaged in providing   
,pr,e,p and ,,pep information and       
services2 and  7#b7 may include-- 7,a7 a
 ,federally qualified health center 7as 
defined in section #ahfa7;aa77#d7 of the
 ,social ,security ,act72  7,b7 a family
 planning grantee 7other than ,states7  
funded under section #ajja2  7,c7 a     
rural health clinic 7as defined in      
section #ahfa7;aa77#b7 of the ,social   
,security ,act72  7,d7 a health facility
 operated by or pursuant to a contract  
with the ,indian ,health ,service2  7,e7
 a community-based organization1 clinic1
 hospital1 or other health facility that

 provides services to individuals at    
risk for or living with ,,hiv2 and  7,f7
 a nonprofit private entity providing   
comprehensive primary care to           
populations at risk of ,,hiv1 including 
faith-based and community-based         
organizations4  7d7 ,awards ,in         
determining whether to award a grant1   
and the grant amount for each grant     
awarded1 the ,secretary shall consider  
the grant application and the need for  
,pr,e,p and ,,pep services in the area1 
the number of uninsured and underinsured
 individuals in the area1 and how the   
,state1 territory1 or ,indian ,tribe    
coordinates ,pr,e,p and ,,pep activities
 with the directly funded entity1 if the
 ,state1 territory1 or ,indian ,tribe   
applies for the funds4  7e7 ,use of     
funds  7#a7 ,in general ,any ,state1    
territory1 ,indian ,tribe1 or directly  
eligible entity that is awarded funds   
under subsection 7a7 shall use such     
funds for eligible ,pr,e,p and ,,pep    
expenses4  7#b7 ,eligible prep expenses 

,the ,secretary shall publish a list of 
expenses that qualify as eligible       
,pr,e,p and ,,pep expenses for purposes 
of this section1 which shall include--  
7,a7 any prescription drug approved by  
the ,food and ,drug ,administration for 
the prevention of ,,hiv1 administrative 
fees for such drugs1 laboratory and     
other diagnostic procedures associated  
with the use of such drugs1 and clinical
 follow-up and monitoring1 including any
 related services recommended in current
 ,united ,states ,public ,health        
,service clinical practice guidelines1  
without limitation2  7,b7 outreach and  
public education activities directed    
toward populations overrepresented in   
the domestic ,,hiv epidemic that        
increase awareness about the existence  
of ,pr,e,p and ,,pep1 provide education 
about access to and health care coverage
 of ,pr,e,p and ,,pep1 ,pr,e,p and ,,pep
 adherence programs1 and counter stigma 
associated with the use of ,pr,e,p and  
,,pep2  7,c7 outreach activities        

directed toward physicians and other    
providers that provide education about  
,pr,e,p and ,,pep2 and  7,d7 adherence  
services and counseling1 including      
personnel costs for ,pr,e,p navigators  
to retain patients in care4  7f7 ,report
 to ,congress ,the ,secretary shall1 in 
each of the first #e years beginning one
 year after the date of the enactment of
 the ,pr,e,p ,access and ,coverage ,act 
of #bjbc1 submit to ,congress1 and make 
public on the internet website of       
,department of ,health and ,human       
,services1 a report on the impact of any
 grants provided to ,states1            
territories1 ,indian ,tribes1 and       
directly eligible entities for the      
establishment and support of            
pre-exposure prophylaxis programs under 
this section4  7g7 ,authorization of    
appropriations ,to carry out this       
section1 there are authorized to be     
appropriated such sums as may be        
necessary for each of fiscal years #bjbd
 through #bjbi4  4  #h4 ,clarification  

,this ,act1 including the amendments    
made by this ,act1 shall apply          
notwithstanding any other provision of  
law1 including ,public ,law #ajc-ada4   
#i4 ,private right of action ,any person
 aggrieved by a violation of this ,act1 
including the amendments made by this   
,act1 may commence a civil action in an 
appropriate ,united ,states ,district   
,court or other court of competent      
jurisdiction to obtain relief as allowed
 by law as either an individual or      
member of a class4 ,if the plaintiff is 
the prevailing party in such an action1 
the court shall order the defendant to  
pay the costs and reasonable attorney   
fees of the plaintiff4  #aj4            
,enforcement  7a7 ,in general ,the      
,secretary of ,health and ,human        
,services1 in consultation with the     
,centers for ,disease ,control and      
,prevention1 shall-- 7#a7 issue guidance
 regarding the implementation of the    
coverage requirements established under 
this ,act1 including the amendments made

 by this ,act1 including with respect to
 implementation of such coverage        
requirements2  7#b7 develop and         
disseminate educational materials1      
including billing and coding documents2 
7#c7 provide technical assistance to    
,state insurance commissioners2  7#d7   
provide technical assistance to eligible
 entities regarding responding to       
consumer complaints and assisting in    
resolving such complaints2 and  7#e7    
work with other ,federal agencies to    
assist in enforcement and compliance4   
7b7 ,compliance  7#a7 ,in general ,the  
,secretary of ,health and ,human        
,services1 the ,secretary of ,labor1 and
 the ,secretary of the ,treasury1 in    
consultation with the ,director of the  
,centers for ,disease ,control and      
,prevention1 shall monitor compliance by
 group health plans and health insurance
 issuers with coverage requirements     
established under title ,,xxvii of the  
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg et seq471 as amended  

by section #c7 and shall take           
appropriate enforcement actions under   
the ,public ,health ,service ,act1 the  
,employee ,retirement ,income ,security 
,act of #aigd1 and the ,internal        
,revenue ,code of #aihf4  7#b7 ,insurer 
submissions to the ,secretary ,beginning
 not later than #a year after the date  
of enactment of this ,act1 each group   
health plan and health insurance issuer 
offering group or individual health     
insurance coverage shall submit to the  
,secretary of ,health and ,human        
,services1 at such time as such         
secretary1 in coordination with the     
,secretary of ,labor and the ,secretary 
of the ,treasury1 shall require1 but not
 less frequently than annually for the  
#aj-year period beginning on such date  
of enactment1 data demonstrating        
compliance with the coverage            
requirements described in paragraph     
7#a71 including aggregate data on the   
number of claims received by such plans 
and issuers for ,,hiv prevention        

services and the cost-sharing for       
enrollees with respect to such claims4  
7#c7 ,reports to ,congress ,not later   
than #b years after the enactment of    
this ,act and every #b years thereafter 
for the #aj-year period beginning on    
such date of enactment1 the ,secretary  
of ,health and ,human ,services1 the    
,secretary of ,labor1 and the ,secretary
 of the ,treasury 7collectively referred
 to in this section as the ,secretaries7
 shall jointly submit to ,congress and  
make publicly available a report to     
assess the prevalence of noncompliance  
with the coverage requirements described
 in paragraph 7#a74 ,each such report   
shall include-- 7,a7 aggregate          
information about group health plans and
 health insurance issuers that the      
,secretaries determine to be out of     
compliance with such requirements2 and  
7,b7 steps the ,secretaries have taken  
to address incidences of such           
noncompliance4  7#d7 ,definitions ,in   
this subsection1 the terms group health 

plan1 health insurance coverage1 and    
health insurance issuer have the        
meanings given such terms in section    
#bgbi of the ,public ,health ,service   
,act 7#db ,u4,s4,c4 #cjj;gg-#ia74