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D.C. Council unanimously approves stronger PrEP/PEP insurance protections
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Summary
The Council adopted amendments to Bill 206‑159 to require insurers to cover all FDA‑approved PrEP formulations, bar cost‑sharing for initial and follow‑up HIV prevention appointments, and remove redundant prior‑authorization language; sponsors said the changes protect access and align local law with federal guidance.
The District of Columbia Council on Tuesday unanimously approved amendments to Bill 206‑159 to strengthen access to HIV prevention medications and clarify insurer obligations.
Councilmember Kristalina Henderson and Councilmember Parker circulated an amendment that, they said, makes three changes: it ensures insurers cover all formulations of PrEP currently approved by the Food and Drug Administration and preserves that requirement if federal guidance changes; it clarifies that insurers may not impose cost sharing for initial or follow‑up appointments related to HIV prevention; and it removes the redundant phrase "prior authorization" from a definition of medically unnecessary restrictions.
"This amendment addresses concerns from advocates regarding cost sharing and preserves a strong PrEP coverage requirement consistent with federal guidance," Henderson said as she described the changes. A council member asked whether the amendment carried a fiscal cost; Henderson replied that a fiscal impact statement exists and reflects no cost to the District.
Councilmember Pinto, who spoke in support of the bill on the floor, thanked Henderson and others for incorporating provisions from her 2025 amendment and said the changes reduce barriers to lifesaving prevention drugs. "PrEP gives individuals the ability to protect themselves independently," Pinto said, citing Centers for Disease Control and Prevention statistics about HIV prevalence and new diagnoses.
Councilmember Parker, who introduced the Prep DC Act in 2025 and shepherded committee changes, said the measure prevents insurers from using prescription information to affect eligibility or premium rates and forbids deductibles, coinsurance or other cost sharing for PrEP or PEP.
The measure passed by voice vote with no recorded opposition. Sponsors said the law embeds protections available under the Affordable Care Act into local law to ensure continuity of access for District residents.
The Council's action was on final (final reading) disposition of the bill as amended; the sponsors said the changes will remain in place even if federal policy evolves.
