HB 1301 — An Act requiring health insurance policies to provide coverage for pre-exposure prophylaxis and post-exposure prophylaxis HIV medication and associated laboratory tests and patient visits.

PRINTER'S NO.   1495

                   THE GENERAL ASSEMBLY OF PENNSYLVANIA



                       HOUSE BILL
                       No. 1301
                                              Session of
                                                2025

     INTRODUCED BY KHAN, KENYATTA, KOSIEROWSKI, KRAJEWSKI, SCOTT,
        GIRAL, SANCHEZ, GUENST, HANBIDGE, PIELLI, MALAGARI, MAYES,
        HOHENSTEIN, CEPEDA-FREYTIZ, STEELE, HILL-EVANS, OTTEN, GREEN,
        DALEY, BOROWSKI AND CARROLL, APRIL 28, 2025

     REFERRED TO COMMITTEE ON HEALTH, APRIL 28, 2025


                                   AN ACT
 1   Requiring health insurance policies to provide coverage for pre-
 2      exposure prophylaxis and post-exposure prophylaxis HIV
 3      medication and associated laboratory tests and patient
 4      visits.
 5      The General Assembly of the Commonwealth of Pennsylvania
 6   hereby enacts as follows:
 7   Section 1.   Short title.
 8      This act shall be known and may be cited as the PrEP and PEP
 9   for Pennsylvania Act.
10   Section 2.   Definitions.
11      The following words and phrases when used in this act shall
12   have the meanings given to them in this section unless the
13   context clearly indicates otherwise:
14      "Health care provider."   A licensed hospital or health care
15   facility or a person licensed, certified or otherwise regulated
16   to provide health care services under the laws of this
17   Commonwealth, including a physician, psychologist, emergency
18   medical services worker, advanced practice registered nurse or
 1   physician's assistant.
 2      "Health insurance policy."      As follows:
 3          (1)    An individual or group health insurance policy,
 4      contract or plan that provides medical or health care
 5      coverage by a health care provider on an expense-incurred
 6      service or prepaid basis that is offered by or is governed
 7      under any of the following:
 8                 (i)    The act of May 17, 1921 (P.L.682, No.284), known
 9          as The Insurance Company Law of 1921, including section
10          630 of that act.
11                 (ii)    The act of December 29, 1972 (P.L.1701,
12          No.364), known as the Health Maintenance Organization
13          Act.
14                 (iii)    40 Pa.C.S. Ch. 61 (relating to hospital plan
15          corporations) or 63 (relating to professional health
16          services plan corporations).
17          (2)    The term does not include accident only, fixed
18      indemnity, hospital indemnity, limited benefit, credit,
19      dental, vision, specified disease, Medicare supplement, long-
20      term care, disability income, workers' compensation,
21      automobile medical payment insurance or a policy under which
22      benefits are provided by the Federal Government to active or
23      former military personnel and their dependents.
24      "HIV."    The human immunodeficiency virus.
25      "PEP."    A post-exposure prophylaxis HIV medication that is
26   approved by the United States Food and Drug Administration and
27   that can be taken as a prophylaxis to prevent the transmission
28   of the human immunodeficiency virus after a person is exposed.
29      "PrEP."    A pre-exposure prophylaxis HIV medication that is
30   approved by the United States Food and Drug Administration and

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 1   that can be taken as a prophylaxis to prevent the transmission
 2   of the human immunodeficiency virus before a person is exposed.
 3      "Prescriber."     A person licensed, registered or otherwise
 4   lawfully authorized to distribute, dispense or administer
 5   medication.
 6   Section 3.     Mandated coverage.
 7      (a)   Requirements.--
 8            (1)   A health insurance policy that is offered, issued or
 9      renewed in this Commonwealth on or after the effective date
10      of this subsection shall provide coverage for all the
11      expenses associated with PEP and PrEP, including the costs of
12      associated laboratory tests, patient visits to a health care
13      provider for the purpose of HIV medication counseling and
14      patient visits to a prescriber to have PEP and PrEP
15      prescribed or maintained.
16            (2)   A patient shall not incur any copay, coinsurance,
17      deductible or other costsharing for any of the expenses
18      associated with PEP and PrEP, including the costs of
19      associated laboratory tests, patient visits to a health care
20      provider for the purpose of HIV medication counseling and
21      patient visits to a prescriber to have PEP or PrEP prescribed
22      or maintained.
23      (b)   Specialty tier.--A provider of a health insurance policy
24   may not move a PEP or PrEP, or an associated laboratory service
25   for monitoring, visit to a health care provider or visit to a
26   prescriber, into a specialty tier solely for monetary gain.
27      (c)   Counseling.--Unless medically necessary, a health
28   insurance policy shall not require counseling by an infectious
29   disease specialist or immunologist as a condition to receive PEP
30   or PrEP, or an associated laboratory service for monitoring,

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 1   visit to a health care provider or visit to a prescriber.
 2   Section 4.   Applicability.
 3      This act shall apply as follows:
 4          (1)   For health insurance policies for which either rates
 5      or forms are required to be filed with the Federal Government
 6      or the Insurance Department, this act shall apply to any
 7      policy for which a form or rate is first filed on or after
 8      the effective date of this paragraph.
 9          (2)   For health insurance policies for which neither
10      rates nor forms are required to be filed with the Federal
11      Government or the Insurance Department, this act shall apply
12      to any policy issued or renewed on or after 180 days after
13      the effective date of this paragraph.
14   Section 5.   Effective date.
15      This act shall take effect in 60 days.




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