Senate passes bill requiring insurance coverage for PrEP and PEP with clarified protections

Senator Pinkney brought House Substitute 1 for House Bill 200 (with Senate Amendment 1 and House Amendment 1) to the floor; the measure requires health plans, the state employee plan and Medicaid to cover medications used to prevent HIV infection, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

Senate Amendment 1 clarified that coverage for PrEP and PEP includes essential support services such as assessments for HIV, hepatitis, pregnancy and kidney function; it also adopted a standard definition of "medically necessary," limited health plans' obligation to cover every FDA-approved equivalent, and protected patient access by requiring coverage without cost sharing, prior authorization or step therapy when the treating provider determines a specific medication is medically necessary. The amendment also delayed the bill's effective date to policies issued, renewed or amended after Dec. 31, 2026.

Senator Pinkney described the amendment as preserving the bill's intent while adding clarity and flexibility. He emphasized PEP's time sensitivity, noting it "must be started within 72 hours after possible exposure." After debate and roll calls on the amendment and the amended substitute, the Senate recorded a unanimous roll call of 21 yes, and declared the amended House Substitute 1 for House Bill 200 passed.

The bill aims to reduce insurance barriers to HIV-prevention treatment and to ensure medically necessary medications are available without administrative impediments.