H.R. 7189

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7189 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 7189

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

_______________________________________________________________________

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.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

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));''; 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.
<all>