PrEP Access Act

This legislative proposal aims to significantly expand access to HIV prevention services under Medicare Part B by including services furnished by pharmacists. It amends the Social Security Act to define "pharmacist-provided HIV prevention services" as those legally authorized by state law and related to the prevention of human immunodeficiency virus. These covered services encompass evaluation, management, screening, consultation, and counseling related to pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and other evidence-based interventions. This also includes medication administration and associated clinical diagnostic laboratory tests necessary for these prevention strategies. The bill establishes that Medicare will reimburse 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount for these services. Importantly, it prohibits pharmacists from balance billing beneficiaries for these covered HIV prevention services, ensuring predictable costs. These provisions are slated to take effect for services provided on or after January 1, 2027.