H.R. 7853

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7853 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 7853

To increase access to pre-exposure prophylaxis to reduce the 
transmission of HIV.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 5, 2026

Mr. Takano (for himself, Mr. Pocan, and Ms. Balint) introduced the 
following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Oversight and Government 
Reform, Ways and Means, Veterans' Affairs, Armed Services, Natural 
Resources, Financial Services, and Education and Workforce, 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 increase access to pre-exposure prophylaxis to reduce the 
transmission of HIV.

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 and Coverage Act of 
2026''.

SEC. 2. SENSE OF CONGRESS.

It is the sense of Congress that the Department of Labor, the 
Department of Health and Human Services, and the Department of the 
Treasury should ensure compliance with the requirements described in 
this Act.

SEC. 3. COVERAGE REQUIREMENTS.

(a) Private Insurance.--
(1) In general.--Section 2713(a) of the Public Health 
Service Act (42 U.S.C. 300gg-13(a)) is amended--
(A) in paragraph (2), by striking ``; and'' and 
inserting a semicolon;
(B) in paragraph (3), by striking the period and 
inserting a semicolon;
(C) in paragraph (4), by striking the period and 
inserting ``; and'';
(D) by striking paragraph (5);
(E) by adding at the end the following:
``(5) any prescription drug approved by the Food and Drug 
Administration used for the prevention of HIV (other than a 
drug subject to preauthorization requirements consistent with 
section 2729A-11), administrative fees for such drugs, 
laboratory and other diagnostic procedures associated with the 
use of such drugs, and clinical follow-up and monitoring, 
including any related services recommended in current United 
States Public Health Service clinical practice guidelines, 
including policy notes updating those guidelines, without 
limitation.''; and
(F) by adding at the end of the flush text at the 
end the following: ``For the purposes of this Act, and 
for the purposes of any other provision of law, the 
current recommendations of the United States Preventive 
Service Task Force regarding breast cancer screening, 
mammography, and prevention shall be considered the 
most current other than those issued in or around 
November 2009.''.
(2) Grandfathered plans.--Section 1251(a)(4) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18011(a)(4)) is 
amended by adding at the end the following:
``(v) Section 2713(a)(5) (relating to 
coverage without cost-sharing for prescription 
drugs for the prevention of HIV).''.
(3) Prohibition on preauthorization requirements.--
(A) PHSA.--Part D of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-111 et seq.) is 
amended by adding at the end the following:

``SEC. 2799A-12. PROHIBITION ON PREAUTHORIZATION REQUIREMENTS WITH 
RESPECT TO CERTAIN SERVICES.

``A group health plan or a health insurance issuer offering group 
or individual health insurance coverage shall not impose any 
preauthorization requirements with respect to coverage of the services 
described in section 2713(a)(5), except that a plan or issuer may 
impose preauthorization requirements with respect to coverage of a 
particular drug approved under section 505(c) of the Federal Food, 
Drug, and Cosmetic Act or section 351(a) of this Act if such plan or 
issuer provides coverage without any preauthorization requirements for 
a drug that is therapeutically equivalent.''.
(B) ERISA.--
(i) In general.--Subpart B of part 7 of 
subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 
U.S.C. 1185 et seq.) is amended by adding at 
the end the following:

``SEC. 727. PROHIBITION ON PREAUTHORIZATION REQUIREMENTS WITH RESPECT 
TO CERTAIN SERVICES.

``A group health plan or a health insurance issuer offering group 
health insurance coverage shall not impose any preauthorization 
requirements with respect to coverage of the services described in 
section 2713(a)(5) of the Public Health Service Act, except that a plan 
or issuer may impose preauthorization requirements with respect to 
coverage of a particular drug approved under section 505(c) of the 
Federal Food, Drug, and Cosmetic Act or section 351(a) of the Public 
Health Service Act if such plan or issuer provides coverage without any 
preauthorization requirements for a drug that is therapeutically 
equivalent.''.
(ii) Clerical amendment.--The table of 
contents in section 1 of the Employee 
Retirement Income Security Act of 1974 (29 
U.S.C. 1001 et seq.) is amended by inserting 
after the item relating to section 726 the 
following new item:

``Sec. 727. Prohibition on preauthorization requirements with respect 
to certain services.''.
(C) IRC.--
(i) In general.--Chapter 100 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end of subchapter B the 
following:

``SEC. 9827. PROHIBITION ON PREAUTHORIZATION REQUIREMENTS WITH RESPECT 
TO CERTAIN SERVICES.

``A group health plan shall not impose any preauthorization 
requirements with respect to coverage of the services described in 
section 2713(a)(5) of the Public Health Service Act, except that a plan 
may impose preauthorization requirements with respect to coverage of a 
particular drug approved under section 505(c) of the Federal Food, 
Drug, and Cosmetic Act or section 351(a) of the Public Health Service 
Act if such plan provides coverage without any preauthorization 
requirements for a drug that is therapeutically equivalent.''.
(ii) Clerical amendment.--The table of 
sections for subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end the following new item:

``Sec. 9827. Prohibition on preauthorization requirements with respect 
to certain services.''.
(b) Coverage Under Federal Employees Health Benefits Program.--
Section 8904 of title 5, United States Code, is amended by adding at 
the end the following:
``(c) Any health benefits plan offered under this chapter shall 
include benefits for, and may not impose any cost-sharing requirements 
for any prescription drug approved by the Food and Drug Administration 
used for the prevention of HIV, administrative fees for such drugs, 
laboratory and other diagnostic procedures associated with the use of 
such drugs, and clinical follow-up and monitoring, including any 
related services recommended in current United States Public Health 
Service clinical practice guidelines, including policy notes updating 
those guidelines, without limitation.''.
(c) Medicaid.--
(1) In general.--Section 1905 of the Social Security Act 
(42 U.S.C. 1396d) is amended by--
(A) in subsection (a)(4), by striking the semicolon 
at the end and inserting ``; and (G) HIV prevention 
services;''; and
(B) by adding at the end the following new 
subsection:
``(ll) HIV Prevention Services.--For purposes of subsection 
(a)(4)(G), the term `HIV prevention services' means all prescription 
drugs used for the prevention of HIV acquisition, administrative fees 
for such drugs, laboratory and other diagnostic procedures associated 
with the use of such drugs, and clinical follow-up and monitoring, 
including any related services recommended in current United States 
Public Health Service clinical practice guidelines, including policy 
notes updating those guidelines without limitation.''.
(2) No cost-sharing.--Title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) is amended--
(A) in section 1916, by inserting ``HIV prevention 
services described in section 1905(a)(4)(G),'' after 
``section 1905(a)(4)(C),'' each place it appears; and
(B) in section 1916A(b)(3)(B), by adding at the end 
the following new clause:
``(xv) HIV prevention services described in 
section 1905(a)(4)(G).''.
(3) Inclusion in benchmark coverage.--Section 1937(b)(7) of 
the Social Security Act (42 U.S.C. 1396u-7(b)(7)) is amended--
(A) in the paragraph heading, by inserting ``and 
hiv prevention services'' after ``supplies''; and
(B) by striking ``includes for any individual 
described in section 1905(a)(4)(C), medical assistance 
for family planning services and supplies in accordance 
with such section'' and inserting ``includes medical 
assistance for HIV prevention services described in 
section 1905(a)(4)(G), and includes, for any individual 
described in section 1905(a)(4)(C), medical assistance 
for family planning services and supplies in accordance 
with such section''.
(d) CHIP.--
(1) In general.--Section 2103 of the Social Security Act 
(42 U.S.C. 1397cc) is amended--
(A) in subsection (a), in the matter preceding 
paragraph (1), by striking ``and (8)'' and inserting 
``(8), and (13)''; and
(B) in subsection (c), by adding at the end the 
following new paragraph:
``(13) HIV prevention services.--Regardless of the type of 
coverage elected by a State under subsection (a), the child 
health assistance provided for a targeted low-income child, 
and, in the case of a State that elects to provide pregnancy-
related assistance pursuant to section 2112, the pregnancy-
related assistance provided for a targeted low-income pregnant 
woman (as such terms are defined for purposes of such section), 
shall include coverage of HIV prevention services (as defined 
in section 1905(ll)).''.
(2) No cost-sharing.--Section 2103(e)(2) of the Social 
Security Act (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the paragraph heading, by inserting ``HIV 
prevention services,'' after ``treatment,''; and
(B) by inserting ``HIV prevention services 
described in subsection (c)(13),'' before ``or for 
pregnancy-related assistance''.
(3) Effective date.--
(A) In general.--Subject to subparagraph (B), the 
amendments made by subsection (c) and this subsection 
shall take effect on January 1, 2027.
(B) Delay permitted if state legislation 
required.--In the case of a State plan approved under 
title XIX or XXI of the Social Security Act which the 
Secretary of Health and Human Services determines 
requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the 
additional requirements imposed by this section, the 
State plan shall not be regarded as failing to comply 
with the requirements of such title solely on the basis 
of the failure of the plan to meet such additional 
requirements before the 1st day of the 1st calendar 
quarter beginning after the close of the 1st regular 
session of the State legislature that ends after the 1-
year period beginning with the date of enactment of 
this section. For purposes of the preceding sentence, 
in the case of a State that has a 2-year legislative 
session, each year of the session is deemed to be a 
separate regular session of the State legislature.
(e) Coverage and Elimination of Cost-Sharing Under Medicare.--
(1) Coverage of hiv prevention services under part b.--
(A) Coverage.--
(i) In general.--Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended--
(I) in subparagraph (JJ), by 
striking ``and'' at the end;
(II) in subparagraph (KK), by 
inserting ``and'' at the end; and
(III) by adding at the end the 
following new subparagraph:
``(LL) HIV prevention services (as defined in 
subsection (ooo));''.
(ii) Definition.--Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is 
amended by adding at the end the following new 
subsection:
``(ooo) HIV Prevention Services.--The term `HIV prevention 
services' means--
``(1) drugs or biologicals approved by the Food and Drug 
Administration for the prevention of HIV;
``(2) administrative fees for such drugs;
``(3) laboratory and other diagnostic procedures associated 
with the use of such drugs; and
``(4) clinical follow-up and monitoring, including any 
related services recommended in current United States Public 
Health Service clinical practice guidelines, including policy 
notes updating those guidelines, without limitation.''.
(B) Elimination of coinsurance.--Section 1833(a)(1) 
of the Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended--
(i) by striking ``and (HH)'' and inserting 
``(HH)''; and
(ii) by inserting before the semicolon at 
the end the following: ``, and (II) with 
respect to HIV prevention services (as defined 
in section 1861(ooo)), the amount paid shall be 
100 percent of (i) except as provided in clause 
(ii), the lesser of the actual charge for the 
service or the amount determined under the fee 
schedule that applies to such services under 
this part, and (ii) in the case of such 
services that are covered OPD services (as 
defined in subsection (t)(1)(B)), the amount 
determined under subsection (t)''.
(C) Exemption from part b deductible.--The first 
sentence of section 1833(b) of the Social Security Act 
(42 U.S.C. 1395l(b)) is amended--
(i) by striking ``, and (13)'' and 
inserting ``(13)''; and
(ii) by striking ``1861(n)..'' and 
inserting ``1861(n), and (14) such deductible 
shall not apply with respect to HIV prevention 
services (as defined in section 
1861(ooo)(1)).''.
(D) Effective date.--The amendments made by this 
paragraph shall apply to items and services furnished 
on or after January 1, 2027.
(2) Elimination of cost-sharing for drugs for the 
prevention of hiv under part d.--
(A) In general.--Section 1860D-2 of the Social 
Security Act (42 U.S.C. 1395w-102) is amended--
(i) in subsection (b)--
(I) in paragraph (1)(A), by 
striking ``and (9)'' and inserting ``, 
(9), and (10)'';
(II) in paragraph (2)--
(aa) in subparagraph (A), 
by striking ``and (9)'' and 
inserting ``, (9), and (10)'';
(bb) in subparagraph 
(C)(i), in the matter preceding 
subclause (I), by striking 
``and (9)'' and inserting 
``(9), and (10)''; and
(cc) in subparagraph 
(D)(i), in the matter preceding 
subclause (I), by striking 
``and (9)'' and inserting 
``(9), and (10)'';
(III) in paragraph (3)(A), in the 
matter preceding clause (i), by 
striking ``and (9)'' and inserting 
``(9), and (10)'';
(IV) in paragraph (4)(A)(i), by 
striking ``and (9)'' and inserting ``, 
(9), and (10)''; and
(V) by adding at the end the 
following new paragraph:
``(10) Elimination of cost-sharing for drugs for the 
prevention of hiv.--For plan years beginning on or after 
January 1, 2027, with respect to a covered part D drug that is 
for the prevention of HIV--
``(A) the deductible under paragraph (1) shall not 
apply; and
``(B) there shall be no coinsurance or other cost-
sharing under this part with respect to such drug.''; 
and
(ii) in subsection (c), by adding at the 
end the following new paragraph:
``(7) Treatment of cost-sharing for drugs for the 
prevention of hiv.--The coverage is provided in accordance with 
subsection (b)(10).''.
(B) Conforming amendments to cost-sharing for low-
income individuals.--Section 1860D-14(a) of the Social 
Security Act (42 U.S.C. 1395w-114(a)) is amended--
(i) in paragraph (1)(D), in each of clauses 
(ii) and (iii), by striking ``paragraph (6)'' 
and inserting ``paragraphs (6) and (7)'';
(ii) in paragraph (2)--
(I) in subparagraph (B), by 
striking ``and (9)'' and inserting ``, 
(9), and (10)'';
(II) in subparagraph (D), by 
striking ``paragraph (6)'' and 
inserting ``paragraphs (6) and (7)''; 
and
(III) in subparagraph (E), by 
striking ``paragraph (6)'' and 
inserting ``paragraphs (6) and (7)''; 
and
(iii) by adding at the end the following 
new paragraph:
``(7) No application of cost-sharing or deductible for 
drugs for the prevention of hiv.--For plan years beginning on 
or after January 1, 2027, with respect to a covered part D drug 
that is for the prevention of HIV--
``(A) the deductible under section 1860D-2(b)(1) 
shall not apply; and
``(B) there shall be no cost-sharing under this 
section with respect to such drug.''.
(f) Coverage of HIV Prevention Treatment by Department of Veterans 
Affairs.--
(1) Elimination of medication copayments.--Section 1722A(a) 
of title 38, United States Code, is amended by adding at the 
end the following new paragraph:
``(5) Paragraph (1) does not apply to a medication for the 
prevention of HIV.''.
(2) Elimination of hospital care and medical services 
copayments.--Section 1710 of such title is amended--
(A) in subsection (f)--
(i) by redesignating paragraph (5) as 
paragraph (6); and
(ii) by inserting after paragraph (4) the 
following new paragraph (5):
``(5) A veteran shall not be liable to the United States under this 
subsection for any amounts for laboratory and other diagnostic 
procedures associated with the use of any prescription drug approved by 
the Food and Drug Administration and used for the prevention of HIV, 
administrative fees for such a drug, or clinical follow-up and 
monitoring, including any related services recommended in current 
United States Public Health Service clinical practice guidelines, 
including policy notes updating those guidelines, without 
limitation.''; and
(B) in subsection (g)(3), by adding at the end the 
following new subparagraph:
``(C) Any prescription drug approved by the Food and Drug 
Administration and used for the prevention of HIV, 
administrative fees for such a drug, laboratory and other 
diagnostic procedures associated with the use of such a drug, 
and clinical follow-up and monitoring, including any related 
services recommended in current United States Public Health 
Service clinical practice guidelines, including policy notes 
updating those guidelines, without limitation.''.
(3) Inclusion as preventive health service.--Section 
1701(9) of such title is amended--
(A) in subparagraph (K), by striking ``; and'' and 
inserting a semicolon;
(B) by redesignating subparagraph (L) as 
subparagraph (M); and
(C) by inserting after subparagraph (K) the 
following new subparagraph (L):
``(L) any prescription drug approved by the Food 
and Drug Administration and used for the prevention of 
HIV, administrative fees for such a drug, laboratory 
and other diagnostic procedures associated with the use 
of such a drug, and clinical follow-up and monitoring, 
including any related services recommended in current 
United States Public Health Service clinical practice 
guidelines, including policy notes updating those 
guidelines, without limitation; and''.
(g) Coverage of HIV Prevention Treatment by Department of 
Defense.--
(1) In general.--Chapter 55 of title 10, United States 
Code, is amended by inserting after section 1074o the following 
new section:
``Sec. 1074p. Coverage of HIV prevention treatment
``(a) In General.--The Secretary of Defense shall ensure coverage 
under the TRICARE program of HIV prevention treatment described in 
subsection (b) for any beneficiary under section 1074(a) of this title.
``(b) HIV Prevention Treatment Described.--HIV prevention treatment 
described in this subsection includes any prescription drug approved by 
the Food and Drug Administration and used for the prevention of HIV, 
administrative fees for such a drug, laboratory and other diagnostic 
procedures associated with the use of such a drug, and clinical follow-
up and monitoring, including any related services recommended in 
current United States Public Health Service clinical practice 
guidelines, including policy notes updating those guidelines, without 
limitation.
``(c) No Cost-Sharing.--Notwithstanding section 1075, 1075a, or 
1074g(a)(6) of this title or any other provision of law, there is no 
cost-sharing requirement for HIV prevention treatment covered under 
this section.''.
(2) Clerical amendment.--The table of sections at the 
beginning of such chapter is amended by inserting after the 
item relating to section 1074o the following new item:

``1074p. Coverage of HIV prevention treatment.''.
(h) Indian Health Service Testing, Monitoring, and Prescription 
Drugs for the Prevention of HIV.--Title II of the Indian Health Care 
Improvement Act is amended by inserting after section 223 (25 U.S.C. 
1621v) the following:

``SEC. 224. TESTING, MONITORING, AND PRESCRIPTION DRUGS FOR THE 
PREVENTION OF HIV.

``(a) In General.--The Secretary, acting through the Director of 
HIV/AIDS Prevention and Treatment under section 832, shall provide, 
without limitation, funding for any prescription drug approved by the 
Food and Drug Administration for the prevention of human 
immunodeficiency virus (commonly known as `HIV'), administrative fees 
for that drug, laboratory and other diagnostic procedures associated 
with the use of that drug, and clinical follow-up and monitoring, 
including any related services recommended in current Public Health 
Service clinical practice guidelines, including policy notes updating 
those guidelines.
``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out this section.''.
(i) Effective Date.--The amendments made by subsections (a), (b), 
(e), (f), (g), and (h) shall take effect with respect to plan years 
beginning on or after January 1, 2027.

SEC. 4. PROHIBITION ON DENIAL OF COVERAGE OR INCREASE IN PREMIUMS OF 
LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE FOR 
INDIVIDUALS TAKING MEDICATION FOR THE PREVENTION OF HIV 
ACQUISITION.

(a) Prohibition.--Notwithstanding any other provision of law, it 
shall be unlawful to--
(1) decline or limit coverage of an individual under any 
life insurance policy, disability insurance policy, or long-
term care insurance policy, on account of the individual taking 
medication for the purpose of preventing the acquisition of 
HIV;
(2) preclude an individual from taking medication for the 
purpose of preventing the acquisition of HIV as a condition of 
receiving a life insurance policy, disability insurance policy, 
or long-term care insurance policy;
(3) consider whether an individual is taking medication for 
the purpose of preventing the acquisition of HIV in determining 
the premium rate for coverage of such individual under a life 
insurance policy, disability insurance policy, or long-term 
care insurance policy; or
(4) otherwise discriminate in the offering, issuance, 
cancellation, amount of such coverage, price, or any other 
condition of a life insurance policy, disability insurance 
policy, or long-term care insurance policy for an individual, 
based solely and without any additional actuarial risks upon 
whether the individual is taking medication for the purpose of 
preventing the acquisition of HIV.
(b) Enforcement.--A State insurance regulator may take such actions 
to enforce subsection (a) as are specifically authorized under the laws 
of such State.
(c) Definitions.--In this section:
(1) Disability insurance policy.--The term ``disability 
insurance policy'' means a contract under which an entity 
promises to pay a person a sum of money in the event that an 
illness or injury resulting in a disability prevents such 
person from working.
(2) Life insurance policy.--The term ``life insurance 
policy'' means a contract under which an entity promises to pay 
a designated beneficiary a sum of money upon the death of the 
insured.
(3) Long-term care insurance policy.--The term ``long-term 
care insurance policy'' means a contract for which the only 
insurance protection provided under the contract is coverage of 
qualified long-term care services (as defined in section 
7702B(c) of the Internal Revenue Code of 1986).

SEC. 5. PUBLIC EDUCATION CAMPAIGN.

Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399V-8. PRE-EXPOSURE PROPHYLAXIS AND POST-EXPOSURE PROPHYLAXIS 
EDUCATION CAMPAIGNS.

``(a) Public Education Campaign.--
``(1) In general.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, in 
consultation with the Director of the Office of Infectious 
Disease and HIV/AIDS Policy, shall establish a public health 
campaign for the purpose of educating the public on medication 
for the prevention of HIV acquisition.
``(2) Requirements.--In carrying out this subsection, the 
Secretary shall ensure cultural competency and efficacy within 
high-need communities in which PrEP or PEP are underutilized by 
developing the campaign in collaboration with organizations 
that are indigenous to communities that are overrepresented in 
the domestic HIV epidemic, including communities of color and 
the lesbian, gay, bisexual, transgender, and queer community. 
The Secretary shall ensure that the campaign is designed to 
increase awareness of the safety and effectiveness of PrEP and 
PEP, the recommended clinical practices for providing PrEP-
related and PEP-related clinical care, and the local 
availability of PrEP and PEP providers, and to counter stigma 
associated with the use of PrEP and PEP.
``(3) Evaluation of program.--The Secretary shall develop 
measures to evaluate the effectiveness of activities conducted 
under this subsection that are aimed at reducing disparities in 
access to PrEP and PEP and supporting the local community. Such 
measures shall evaluate community outreach activities, language 
services, workforce cultural competence, and other areas as 
determined by the Secretary.
``(b) Provider Education Campaign.--
``(1) In general.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, the 
Administrator of the Health Resources and Services 
Administration, and the Office of Infectious Disease and HIV/
AIDS Policy, shall establish a provider campaign for the 
purpose of educating prescribers and other associated health 
professionals on medication for the prevention of HIV 
acquisition.
``(2) Requirements.--In carrying out this subsection, the 
Secretary shall increase awareness and readiness among health 
care providers to offer PrEP or PEP, as appropriate, with a 
focus on areas of high-need communities in which PrEP or PEP is 
underutilized by developing an educational campaign with input 
from health care providers and organizations from communities 
that are disproportionately affected by the domestic HIV 
epidemic, including communities of color and the lesbian, gay, 
bisexual, transgender, and queer community. The Secretary shall 
ensure that the campaign is designed to increase awareness of 
the safety and effectiveness of PrEP and PEP, the recommended 
clinical practices for providing PrEP-related and PEP-related 
clinical care, cultural competency among PrEP and PEP 
prescribers, and to counter stigma associated with the use of 
PrEP and PEP.
``(3) Evaluation of program.--The Secretary shall develop 
measures to evaluate the effectiveness of activities conducted 
under this subsection that are aimed at increasing the number 
of health care professionals offering PrEP and PEP and reducing 
disparities in access to PrEP and PEP. Such measures shall 
evaluate availability of PrEP and PEP services, education and 
outreach activities, language services, workforce cultural 
competence, and other areas as determined by the Secretary.
``(c) Definitions.--In this section and section 399V-9--
``(1) the term `PEP' means any drug or combination of drugs 
approved by the Food and Drug Administration for preventing HIV 
transmission after a sexual or other exposure associated with a 
high risk of HIV transmission; and
``(2) the term `PrEP' means any drug approved by the Food 
and Drug Administration for the purpose of pre-exposure 
prophylaxis with respect to HIV.
``(d) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for each of fiscal years 2026 through 2030.''.

SEC. 6. PATIENT CONFIDENTIALITY.

The Secretary of Health and Human Services shall amend the 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note), as 
necessary, to ensure that individuals are able to access the benefits 
described in section 2713(a)(5) under a family plan without any other 
individual enrolled in such family plan, including a primary subscriber 
of or policyholder, being informed of such use of such benefits.

SEC. 7. PREP AND PEP FUNDING.

Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 5, is further amended by adding at 
the end the following:

``SEC. 399V-9. PRE-EXPOSURE PROPHYLAXIS AND POST-EXPOSURE PROPHYLAXIS 
FUNDING.

``(a) In General.--Not later than 1 year after the date of 
enactment of the PrEP Access and Coverage Act of 2026, the Secretary 
shall establish a program that awards grants to States, territories, 
Indian Tribes, and directly eligible entities for the establishment and 
support of pre-exposure prophylaxis (referred to in this section as 
`PrEP') and post-exposure prophylaxis (referred to in this section as 
`PEP') programs.
``(b) Applications.--To be eligible to receive a grant under 
subsection (a), a State, territory, Indian Tribe, or directly eligible 
entity shall--
``(1) submit an application to the Secretary at such time, 
in such manner, and containing such information as the 
Secretary may require, including a plan describing how any 
funds awarded will be used to increase access to PrEP for 
uninsured and underinsured individuals and reduce disparities 
in access to PrEP and PEP for uninsured and underinsured 
individuals and reduce disparities in access to PrEP and PEP; 
and
``(2) appoint a PrEP and PEP grant administrator to manage 
the program.
``(c) Directly Eligible Entity.--For purposes of this section, the 
term `directly eligible entity'--
``(1) means a nonprofit entity engaged in providing PrEP 
and PEP information and services; and
``(2) may include--
``(A) a Federally qualified health center (as 
defined in section 1861(aa)(4) of the Social Security 
Act);
``(B) a family planning grantee (other than States) 
funded under section 1001;
``(C) a rural health clinic (as defined in section 
1861(aa)(2) of the Social Security Act);
``(D) a health facility operated by or pursuant to 
a contract with the Indian Health Service;
``(E) a community-based organization, clinic, 
hospital, or other health facility that provides 
services to individuals at risk for or living with HIV; 
and
``(F) a nonprofit private entity providing 
comprehensive primary care to populations at risk of 
HIV, including faith-based and community-based 
organizations.
``(d) Awards.--In determining whether to award a grant, and the 
grant amount for each grant awarded, the Secretary shall consider the 
grant application and the need for PrEP and PEP services in the area, 
the number of uninsured and underinsured individuals in the area, and 
how the State, territory, or Indian Tribe coordinates PrEP and PEP 
activities with the directly funded entity, if the State, territory, or 
Indian Tribe applies for the funds.
``(e) Use of Funds.--
``(1) In general.--Any State, territory, Indian Tribe, or 
directly eligible entity that is awarded funds under subsection 
(a) shall use such funds for eligible PrEP and PEP expenses.
``(2) Eligible prep expenses.--The Secretary shall publish 
a list of expenses that qualify as eligible PrEP and PEP 
expenses for purposes of this section, which shall include--
``(A) any prescription drug approved by the Food 
and Drug Administration used for the prevention of HIV, 
administrative fees for such drugs, laboratory and 
other diagnostic procedures associated with the use of 
such drugs, and clinical follow-up and monitoring, 
including any related services recommended in current 
United States Public Health Service clinical practice 
guidelines, including policy notes updating those 
guidelines, without limitation;
``(B) outreach and public education activities 
directed toward populations overrepresented in the 
domestic HIV epidemic that increase awareness about the 
existence of PrEP and PEP, provide education about 
access to and health care coverage of PrEP and PEP, 
PrEP and PEP adherence programs, and counter stigma 
associated with the use of PrEP and PEP;
``(C) outreach activities directed toward 
physicians and other providers that provide education 
about PrEP and PEP; and
``(D) adherence services and counseling, including 
personnel costs for PrEP navigators to retain patients 
in care.
``(f) Report to Congress.--The Secretary shall, in each of the 
first 5 years beginning 1 year after the date of enactment of the PrEP 
Access and Coverage Act of 2026, submit to Congress, and make public on 
the website of Department of Health and Human Services, a report on the 
impact of any grants provided to States, territories, Indian Tribes, 
and directly eligible entities for the establishment and support of 
pre-exposure prophylaxis programs under this section.
``(g) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for each of fiscal years 2026 through 2030.''.

SEC. 8. CLARIFICATION.

This Act, including the amendments made by this Act, shall apply 
notwithstanding any other provision of law, including Public Law 103-
141.

SEC. 9. PRIVATE RIGHT OF ACTION.

Any person aggrieved by a violation of this Act, including the 
amendments made by this Act, may commence a civil action in an 
appropriate United States District Court or other court of competent 
jurisdiction to obtain relief as allowed by law as either an individual 
or member of a class. If the plaintiff is the prevailing party in such 
an action, the court shall order the defendant to pay the costs and 
reasonable attorney fees of the plaintiff.

SEC. 10. ENFORCEMENT.

(a) In General.--The Secretary of Health and Human Services, in 
consultation with the Centers for Disease Control and Prevention, 
shall--
(1) issue guidance regarding the implementation of the 
coverage requirements established under this Act, including the 
amendments made by this Act, including with respect to 
implementation of such coverage requirements;
(2) develop and disseminate educational materials, 
including billing and coding documents based on stakeholder 
consensus-driven recommendations, as appropriate;
(3) provide technical assistance to State insurance 
commissioners;
(4) provide technical assistance to eligible entities 
regarding responding to consumer complaints and assisting in 
resolving such complaints; and
(5) work with other Federal agencies to assist in 
enforcement and compliance.
(b) Compliance.--
(1) In general.--The Secretary of Health and Human 
Services, the Secretary of Labor, and the Secretary of the 
Treasury, in consultation with the Director of the Centers for 
Disease Control and Prevention, shall monitor compliance by 
group health plans and health insurance issuers with coverage 
requirements established under sections 2799A-11 of the Public 
Health Service Act, 726 of the Employee Retirement Income 
Security Act of 1974, and 9826 of the Internal Revenue Code of 
1986 (as added by section 3(a)) and shall take appropriate 
enforcement actions under such Acts and such Code.
(2) Insurer submissions to the secretary.--Beginning not 
later than 1 year after the date of enactment of this Act, each 
group health plan and health insurance issuer offering group or 
individual health insurance coverage shall submit to the 
Secretary of Health and Human Services, at such time as such 
secretary, in coordination with the Secretary of Labor and the 
Secretary of the Treasury, shall require, but not less 
frequently than annually for the 10-year period beginning on 
such date of enactment, data demonstrating compliance with the 
coverage requirements described in paragraph (1), including 
aggregate data on the number of claims received by such plans 
and issuers for HIV prevention services and the cost-sharing 
for enrollees with respect to such claims.
(3) Reports to congress.--Not later than 2 years after the 
date of enactment of this Act and every 2 years thereafter for 
the 10-year period beginning on such date of enactment, the 
Secretary of Health and Human Services, the Secretary of Labor, 
and the Secretary of the Treasury (collectively referred to in 
this section as the ``Secretaries'') shall jointly submit to 
Congress and make publicly available a report to assess the 
prevalence of noncompliance with the coverage requirements 
described in paragraph (1). Each such report shall include--
(A) aggregate information about group health plans 
and health insurance issuers that the Secretaries 
determine to be out of compliance with such 
requirements; and
(B) steps the Secretaries have taken to address 
incidences of such noncompliance.
(4) Definitions.--In this subsection, the terms ``group 
health plan'', ``health insurance coverage'', and ``health 
insurance issuer'' have the meanings given such terms in 
section 2791 of the Public Health Service Act (42 U.S.C. 300gg-
91).
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