H.R. 7189

119 HR 7189 IH: PrEP Access Act
 U.S. House of Representatives
 2026-01-21
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 I  119th CONGRESS  2d Session  H. R. 7189  IN THE HOUSE OF REPRESENTATIVES   January 21, 2026   Mr. Pocan  (for himself,  Mrs. Beatty ,  Ms. Dean of Pennsylvania ,  Mr. Garcia of California ,  Ms. Garcia of Texas ,  Mr. Gottheimer ,  Ms. Norton ,  Mr. Johnson of Georgia ,  Mrs. Ramirez ,  Ms. Ross ,  Mr. Torres of New York , and  Mrs. Watson Coleman ) introduced the following bill; which was referred to the  Committee on Energy and Commerce , and in addition to the Committee on  Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned   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.
1.
Short title
This Act may be cited as the   PrEP Access Act  .
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));
 ; and
(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.