PrEP Access Act
- Sponsor
- Rep. Pocan, Mark [D-WI-2]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jan 21, 2026
Bottom line
The PrEP Access Act expands Medicare Part B coverage for pharmacist-provided HIV prevention services, aiming to increase access to critical preventative care and reduce new HIV infections.
What it actually does
This bill amends the Social Security Act to expand Medicare Part B coverage to include certain HIV prevention services, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), when furnished by pharmacists. It defines these services, establishes a payment methodology for pharmacists, and prohibits balance billing for these services, ensuring beneficiaries are protected from unexpected costs.
Proponents argue
Supporters argue that this bill will significantly improve access to vital HIV prevention services, particularly for Medicare beneficiaries in underserved areas, by leveraging the widespread accessibility of pharmacists. They contend that enabling pharmacists to provide PrEP and PEP, along with related counseling and testing, will reduce new HIV infections, improve public health outcomes, and ultimately lower long-term healthcare costs associated with HIV treatment.
Opponents contend
Critics might raise concerns regarding the appropriate scope of practice for pharmacists in providing complex preventative care without direct physician oversight, potentially leading to fragmented patient care. They may also express apprehension about the overall cost implications for the Medicare program, particularly if there are no clear budgetary offsets, or question the consistency of quality of care across diverse pharmacy settings.
The bill is concise and clearly written, making it straightforward for an informed reader to understand its core provisions and implications quickly.
Section 2(a)
Coverage of Pharmacist-Provided HIV Prevention Services under Medicare Part B
This provision amends Section 1861 of the Social Security Act to explicitly include "pharmacist-provided HIV prevention services" as a covered benefit under Medicare Part B. It defines these services as those furnished by a pharmacist, or incident to a pharmacist's service, that would otherwise be covered if furnished by a physician. These services must be legally authorized by State law and relate to HIV prevention, including evaluation, management, screening, consultation, counseling, medication administration for PrEP/PEP, and related diagnostic lab tests.
Supporters argue
Supporters argue that this provision addresses critical gaps in access to HIV prevention, especially for older adults and those in rural or underserved areas, by allowing highly accessible pharmacists to provide these essential services. They emphasize that pharmacists are trained healthcare professionals capable of delivering these services safely and effectively, thereby improving public health outcomes and reducing healthcare disparities.
Critics contend
Some might argue that expanding pharmacists' scope of practice into complex preventative care without direct physician involvement could lead to fragmented care or missed opportunities for comprehensive health assessments. Concerns could also be raised about ensuring consistent quality of care across different pharmacy settings and the potential for increased costs to Medicare.
Tradeoffs
The bill balances the need for increased access to critical HIV prevention services against potential concerns regarding the traditional scope of practice for pharmacists and the integration of these new services into the existing healthcare delivery model. It also considers the balance between cost savings from prevention and the immediate costs of expanding coverage.
Section 2(b)
Medicare Part B Payment for Pharmacist-Provided HIV Prevention Services
This provision amends Section 1833(a)(1) of the Social Security Act to establish the payment rate for pharmacist-provided HIV prevention services under Medicare Part B. The amount paid will be 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 for such services if furnished by a physician (under section 1848). This means pharmacists would be reimbursed at 85% of the physician fee schedule amount.
Section 2(c)
Prohibition on Balance Billing for Pharmacist Services
This provision amends Section 1842(b)(18) of the Social Security Act to extend existing prohibitions on balance billing to pharmacists providing covered services. This means pharmacists cannot charge Medicare beneficiaries more than the Medicare-approved amount for HIV prevention services, protecting beneficiaries from unexpected out-of-pocket costs beyond their standard co-insurance.