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PrEP Access Act

H.R. 7189 · 119th Congress · Jan 21, 2026 · Lineage

A BILL

To amend title XVIII of the Social Security Act to provide coverage for certain HIV prevention services furnished by pharmacists under the Medicare program.

Section 1 Short title

This Act may be cited as the “PrEP Access Act”.

Sec. 2 Coverage of pharmacist-provided HIV prevention services under Medicare part B

(a)
In general— Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
(1)
in subsection (s)(2)—
(A)
in subparagraph (JJ), by inserting “and” after the semicolon; and
(B)
by adding at the end the following new subparagraph:

“(KK) pharmacist-provided HIV prevention services (as defined in subsection (nnn));”

(2)
by adding at the end the following new subsection:

“(nnn) Pharmacist-provided HIV prevention services—The term ‘pharmacist-provided HIV prevention services’ means such services furnished by a pharmacist, and such services and supplies furnished as incident to the pharmacist’s service, as would otherwise be covered if furnished by a physician or as an incident to a physicians’ service that—

“(1) the pharmacist is legally authorized to furnish under State law; and

“(2) are services related to the prevention of human immunodeficiency virus, including evaluation, management, screening, consultation, and counseling services related to—

“(A) pre-exposure prophylaxis, post-exposure prophylaxis, or other evidence-based interventions for the prevention of human immunodeficiency virus;

“(B) medication administration for such interventions; or

“(C) clinical diagnostic laboratory tests related to such interventions.”

(b)
Payment— Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
(1)
by striking “and (HH)” and inserting “(HH)”; and
(2)
by inserting before the semicolon at the end “, and (II) with respect to pharmacist-provided HIV prevention services (as defined in section 1861(nnn)), the amounts paid shall be equal to 80 percent of the lesser of (i) the actual charge for the services or (ii) 85 percent of the amount determined under the payment basis under section 1848 for such services”.
(c)
Prohibition on balance billing for pharmacist services— Section 1842(b)(18) of the Social Security Act (42 U.S.C. 1395u(b)(18)) is amended—
(1)
in subparagraph (A), by inserting “or a pharmacist” after “a practitioner described in subparagraph (C)”;
(2)
in subparagraph (B)—
(A)
by inserting “, pharmacist,” after “a practitioner described in subparagraph (C)”; and
(B)
in the third sentence—
(i)
by inserting “, pharmacist,” after “a practitioner”; and
(ii)
by inserting “, pharmacist,” after “the practitioner”; and
(3)
in subparagraph (D), by inserting “or a pharmacist” after “a practitioner described in subparagraph (C)”.
(d)
Conforming amendment— Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended—
(1)
in subparagraph (O), by striking “and” at the end;
(2)
in subparagraph (P), by striking the semicolon at the end and inserting “, and”; and
(3)
by adding at the end the following new subparagraph:

“(Q) in the case of pharmacist-provided HIV prevention services (as defined in section 1861(nnn)), which are not reasonable and necessary for the prevention or detection of human immunodeficiency virus;”

(e)
Application— The amendments made by this section shall apply to items and services furnished on or after January 1, 2027.