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STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-FIVE
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H.P. 1122 - L.D. 1687
An Act to Clarify and Increase Access to HIV Prevention Medications
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §3197 is enacted to read:
§3197. Prescribing, dispensing and administering HIV prevention drugs
1. Definition. As used in this section, unless the context otherwise indicates, "HIV
prevention drug" has the same meaning as in Title 32, section 13786-E, subsection 1,
paragraph B.
2. Reimbursement for pharmacists prescribing, dispensing and administering
HIV prevention drugs. No later than January 1, 2027, the department shall provide
reimbursement under the MaineCare program to a pharmacist for prescribing, dispensing
and administering HIV prevention drugs under Title 32, section 13786-E. The department:
A. Shall provide coverage for services provided by the pharmacist under this
subsection;
B. Shall authorize a pharmacist to bill the carrier and receive direct payment for a
service under this subsection that the pharmacist provides to a MaineCare member and
shall identify the pharmacist as the provider in the billing and the claims process for
payment of the service; and
C. May not impose on a pharmacist a practice, education or collaboration requirement
that is inconsistent with or more restrictive than a requirement of state law or an agency
or board rule for the pharmacist to receive payment for a service provided under this
subsection.
3. Reimbursement model. No later than January 1, 2027, the department shall create
and implement under the MaineCare program a reimbursement model to increase access to
HIV prevention drugs administered under Title 32, section 13786-E.
Sec. 2. 24-A MRSA §4317-D, sub-§2, as enacted by PL 2021, c. 265, §4, is
amended to read:
2. Coverage required. A carrier offering a health plan in this State shall provide
coverage for an HIV prevention drug that has been prescribed by a provider or that has
APPROVED
JULY 1, 2025
BY GOVERNOR
CHAPTER
483
PUBLIC LAW
Page 2 - 132LR2100(03)
been prescribed, dispensed and administered by a pharmacist under Title 32, section
13786-E. Coverage under this section is subject to the following.
A. If the federal Food and Drug Administration has approved one or more HIV
prevention drugs that use the same method of administration, a carrier is not required
to cover all approved drugs as long as the carrier covers at least one approved drug for
each method of administration with no out-of-pocket cost. Notwithstanding this
paragraph, a carrier shall provide coverage with no out-of-pocket cost for HIV
prevention drugs for the prevention of the acquisition of HIV infection in accordance
with a rating of A or B in the recommendations of the United States Preventive Services
Task Force or equivalent rating from a successor organization and guidelines issued by
the United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services.
B. A carrier is not required to cover any preexposure prophylaxis drug or post-
exposure prophylaxis drug dispensed or administered by an out-of-network pharmacy
provider unless the enrollee's health plan provides an out-of-network pharmacy benefit.
C. A carrier may not prohibit, or permit a pharmacy benefits manager to prohibit, a
pharmacy provider from prescribing, dispensing or administering any HIV prevention
drugs.
D. A carrier shall authorize a pharmacist to bill the carrier and receive direct payment
for a service that the pharmacist provides to an enrollee pursuant to this section and
shall identify the pharmacist as the provider in the billing and claims process for
payment for the service. A carrier may not impose on a pharmacist, in order for the
pharmacist to receive payment for a service provided pursuant to this section, a
practice, education or collaboration requirement that is inconsistent with or more
restrictive than a requirement of state law or agency or board rules.
Sec. 3. 24-A MRSA §4317-D, sub-§3, as enacted by PL 2021, c. 265, §4, is
amended to read:
3. Limits on prior authorization and step therapy requirements. Notwithstanding
any requirements in section 4304 or 4320‑N to the contrary, a carrier may not subject any
HIV prevention drug to any prior authorization or step therapy requirement except as
provided in this subsection. If the federal Food and Drug Administration has approved one
or more methods of administering HIV prevention drugs, a carrier is not required to cover
all of the approved drugs without prior authorization or step therapy requirements as long
as the carrier covers at least one approved drug for each method of administration without
prior authorization or step therapy requirements. Notwithstanding this subsection, a carrier
shall provide coverage without prior authorization or step therapy requirements for HIV
prevention drugs for the prevention of the acquisition of HIV infection in accordance with
a rating of A or B in the recommendations of the United States Preventive Services Task
Force or equivalent rating from a successor organization and guidelines issued by the
United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services. If prior authorization or step therapy requirements are met for a
particular enrollee with regard to a particular HIV prevention drug, the carrier is required
to cover that drug with no out-of-pocket cost to the enrollee.
Sec. 4. 32 MRSA §13786-E, sub-§2, ¶B, as enacted by PL 2021, c. 265, §6, is
amended to read:
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B. A pharmacist shall dispense or administer a preexposure prophylaxis drug in at least
a 30-day supply, and up to a 60-day supply of an oral medication, or in one
administration of an injectable medication of any duration, as long as all of the
following conditions are met:
(1) The patient tests negative for HIV infection, as documented by a negative HIV
test result obtained within the previous 7 days. If the patient does not provide
evidence of a negative HIV test result in accordance with this subparagraph, the
pharmacist shall order an HIV test. If the test results are not transmitted directly
to the pharmacist, the pharmacist shall verify the test results to the pharmacist's
satisfaction. If the patient tests positive for HIV infection, the pharmacist or person
administering the test shall direct the patient to a primary care provider and provide
a list of primary care providers and clinics within a reasonable travel distance of
the patient's residence;
(2) The patient does not report any signs or symptoms of acute HIV infection on
a self-reporting checklist of acute HIV infection signs and symptoms;
(3) The patient does not report taking any contraindicated medications;
(4) The pharmacist provides counseling to the patient, consistent with CDC
guidelines, on the ongoing use of a preexposure prophylaxis drug. The pharmacist
shall notify the patient that the patient must be seen by a primary care provider to
receive subsequent prescriptions for a preexposure prophylaxis drug and that a
pharmacist may not dispense or administer more than a 60-day supply of a an oral
preexposure prophylaxis drug or one administration of an injectable preexposure
prophylaxis drug of any duration to a single patient once every 2 years without a
prescription;
(5) The pharmacist documents, to the extent possible, the services provided by the
pharmacist in the patient's record in the patient profile record system maintained
by the pharmacy. The pharmacist shall maintain records of preexposure
prophylaxis drugs dispensed or administered to each patient;
(6) The pharmacist does not dispense or administer more than a 60-day supply of
a an oral preexposure prophylaxis drug or one administration of an injectable
preexposure prophylaxis drug of any duration to a single patient once every 2 years,
unless otherwise directed by a practitioner; and
(7) The pharmacist notifies the patient's primary care provider that the pharmacist
completed the requirements specified in this paragraph. If the patient does not have
a primary care provider, or refuses consent to notify the patient's primary care
provider, the pharmacist shall provide the patient a list of physicians, clinics or
other health care providers to contact regarding follow-up care.
Sec. 5. Exemption from review. Notwithstanding the Maine Revised Statutes,
Title 24-A, section 2752, this Act is enacted without review and evaluation by the
Department of Professional and Financial Regulation, Bureau of Insurance.
Sec. 6. Department of Health and Human Services to apply for waiver
under Medicaid program. The Department of Health and Human Services shall apply
to the United States Department of Health and Human Services, Centers for Medicare and
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Medicaid Services for any amendment to the state Medicaid plan or for any waiver under
the state Medicaid program necessary to implement this Act by January 1, 2027.
Sec. 7. Appropriations and allocations. The following appropriations and
allocations are made.
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Medical Care - Payments to Providers 0147
Initiative: Provides funding for MaineCare reimbursement to pharmacists for HIV
prevention medications.
GENERAL FUND 2025-26 2026-27
All Other $0 $1,470
__________ __________
GENERAL FUND TOTAL $0 $1,470
FEDERAL EXPENDITURES FUND 2025-26 2026-27
All Other $0 $15,591
__________ __________
FEDERAL EXPENDITURES FUND TOTAL $0 $15,591
OTHER SPECIAL REVENUE FUNDS 2025-26 2026-27
All Other $0 $1,609
__________ __________
OTHER SPECIAL REVENUE FUNDS TOTAL $0 $1,609
Office of MaineCare Services 0129
Initiative: Provides one-time funding for technology costs to implement MaineCare
reimbursement to pharmacists for HIV prevention medications.
GENERAL FUND 2025-26 2026-27
All Other $0 $42,794
__________ __________
GENERAL FUND TOTAL $0 $42,794
FEDERAL EXPENDITURES FUND 2025-26 2026-27
All Other $0 $131,360
__________ __________
FEDERAL EXPENDITURES FUND TOTAL $0 $131,360
HEALTH AND HUMAN SERVICES,
DEPARTMENT OF
DEPARTMENT TOTALS 2025-26 2026-27
GENERAL FUND $0 $44,264
FEDERAL EXPENDITURES FUND $0 $146,951
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OTHER SPECIAL REVENUE FUNDS $0 $1,609
__________ __________
DEPARTMENT TOTAL - ALL FUNDS $0 $192,824