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EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb1114*
HOUSE BILL 1114
J1, J2 6lr2296
CF 6lr3419
By: Delegates Martinez, Acevero, Clippinger, Fair, Kaiser, Kaufman, Vogel, and
Woorman
Introduced and read first time: February 11, 2026
Assigned to: Health
A BILL ENTITLED
AN ACT concerning 1
HIV Prevention Drugs – Prescribing, Dispensing, and Insurance Coverage 2
FOR the purpose of authorizing pharmacists to prescribe and dispense preexposure 3
prophylaxis for HIV prevention to patients under certain circumstances; requiring 4
the Maryland Medical Assistance Program to provide drugs that are approved by the 5
U.S. Food and Drug Administration for HIV prevention; prohibiting managed care 6
organizations, insurers, nonprofit health service plans, and health maintenance 7
organizations from requiring prior authorization for preexposure prophylaxis for 8
HIV prevention or step therapy or cost–sharing for preexposure prophylaxis for HIV 9
prevention or po stexposure prophylaxis for HIV prevention; requiring the State 10
Board of Pharmacy to develop a certain notification plan and convene a certain 11
workgroup; and generally relating to HIV prevention drugs. 12
BY adding to 13
Article – Health – General 14
Section 15–102.3(p) and 15–103(a)(2)(xxix) 15
Annotated Code of Maryland 16
(2023 Replacement Volume and 2025 Supplement) 17
BY repealing and reenacting, without amendments, 18
Article – Health – General 19
Section 15–103(a)(1) 20
Annotated Code of Maryland 21
(2023 Replacement Volume and 2025 Supplement) 22
BY repealing and reenacting, with amendments, 23
Article – Health – General 24
Section 15–103(a)(2)(xxvii) and (xxviii) and (b)(32) 25
Annotated Code of Maryland 26
(2023 Replacement Volume and 2025 Supplement) 27
2 HOUSE BILL 1114
BY repealing and reenacting, without amendments, 1
Article – Health Occupations 2
Section 12–101(a) 3
Annotated Code of Maryland 4
(2021 Replacement Volume and 2025 Supplement) 5
BY repealing and reenacting, with amendments, 6
Article – Health Occupations 7
Section 12–101(x)(1)(xiii) and (xiv) 8
Annotated Code of Maryland 9
(2021 Replacement Volume and 2025 Supplement) 10
BY adding to 11
Article – Health Occupations 12
Section 12–101(x)(1)(xv) and 12–515 13
Annotated Code of Maryland 14
(2021 Replacement Volume and 2025 Supplement) 15
BY repealing and reenacting, with amendments, 16
Article – Insurance 17
Section 15–858 18
Annotated Code of Maryland 19
(2017 Replacement Volume and 2025 Supplement) 20
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 21
That the Laws of Maryland read as follows: 22
Article – Health – General 23
15–103. 24
(a) (1) The Secretary shall administer the Maryland Medical Assistance 25
Program. 26
(2) The Program: 27
(xxvii) Beginning on January 1, 2026, if providing coverage for the 28
delivery of anesthesia, shall provide coverage for the delivery of anesthesia in accordance 29
with § 15–862 of the Insurance Article; [and] 30
(xxviii) Beginning on January 1, 2026, shall provide calcium score 31
testing in accordance with § 15–863 of the Insurance Article; AND 32
(XXIX) BEGINNING ON JANUARY 1, 2027, SHALL PROVIDE , 33
SUBJECT TO THE LIMIT ATIONS OF THE STATE BUDGET, MEDICALLY APPROPRIATE 34
DRUGS THAT ARE APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION FOR 35
HOUSE BILL 1114 3
HIV PREVENTION, INCLUDING: 1
1. PREEXPOSURE PROPHYLAX IS, AS DEFINED IN § 2
12–515 OF THE HEALTH OCCUPATIONS ARTICLE; AND 3
2. POSTEXPOSURE PROPHYLAXIS. 4
(b) (32) A managed care organization may not apply a prior authorization 5
requirement for a prescription drug used as PREEXPOSURE PROPHYLA XIS OR 6
postexposure prophylaxis for the prevention of HIV if the prescription drug is prescribed 7
for use in accordance with Centers for Disease Control and Prevention Guidelines. 8
Article – Health Occupations 9
12–101. 10
(a) In this title the following words have the meanings indicated. 11
(x) (1) “Practice pharmacy” means to engage in any of the following activities: 12
(xiii) Prescribing and dispensing nicotine replacement therapy 13
medications; [or] 14
(xiv) If the pharmacist is registered with the Nonoccupational 15
Postexposure Prophylaxis (nPEP) Standing Order Program established under § 13–5302 of 16
the Health – General Article, dispensing nonoccupational postexposure prophylaxis (nPEP) 17
medication approved by the U.S. Food and Drug Administration and in accordance with 18
“Updated Guidelines for Antir etroviral Postexposure Prophylaxis After Sexual, Injection 19
Drug Use, or Other Nonoccupational Exposure to HIV – United States 2016” or subsequent 20
guidelines published by the federal Centers for Disease Control and Prevention; OR 21
(XV) PRESCRIBING AND DISPENSING P REEXPOSURE 22
PROPHYLAXIS MEDICATIONS FOR HIV APPROVED BY THE U.S. FOOD AND DRUG 23
ADMINISTRATION AND IN ACCORDANCE WITH “PREEXPOSURE PROPHYLAXIS FOR 24
THE PREVENTION OF HIV INFECTION IN THE UNITED STATES – 2021 UPDATE: A 25
CLINICAL PRACTICE GUIDELINE” OR ANY SUBSEQUENT GUIDELINES PUBLISHED BY 26
THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION. 27
12–515. 28
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 29
INDICATED. 30
(2) “CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS ” MEANS 31
“UPDATED GUIDELINES FOR ANTIRETROVIRAL POSTEXPOSURE PROPHYLAXIS 32
4 HOUSE BILL 1114
AFTER SEXUAL, INJECTION DRUG USE, OR OTHER NONOCCUPATIONAL EXPOSURE 1
TO HIV – UNITED STATES, 2025” OR ANY SUBSEQUENT GUIDELINES PUBLISHED BY 2
THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION. 3
(3) “CDC GUIDELINES FOR PREEX POSURE PROPHYLAXIS ” MEANS 4
“PREEXPOSURE PROPHYLAXIS FOR THE PREVENTION OF HIV INFECTION IN THE 5
UNITED STATES – 2021 UPDATE: A CLINICAL PRACTICE GUIDELINE” OR ANY 6
SUBSEQUENT GUIDELINES PUBLISHED BY THE F EDERAL CENTERS FOR DISEASE 7
CONTROL AND PREVENTION. 8
(4) “POSTEXPOSURE PROPHYLA XIS” MEANS ANY DRUG 9
COMBINATION APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION THAT IS: 10
(I) USED TO PREVENT HIV INFECTION FOLLOWING AN 11
EXPOSURE OR POTENTIAL EXPOSURE TO HIV; AND 12
(II) ADMINISTERED IN ACCORDANCE WITH THE CENTERS FOR 13
DISEASE CONTROL AND PREVENTION, IN THE CDC GUIDELINES FOR 14
POSTEXPOSURE PROPHYLAXIS. 15
(5) “PREEXPOSURE PROPHYLAXIS” MEANS ANY DRUG COMBINATION 16
APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION, INCLUDING ORAL AND 17
INJECTABLE FORMULATIONS, THAT IS: 18
(I) PROVIDED TO AN HIV–NEGATIVE PERSON TO P REVENT 19
HIV INFECTION; AND 20
(II) ADMINISTERED IN ACCOR DANCE WITH THE CENTERS FOR 21
DISEASE CONTROL AND PREVENTION, IN THE CDC GUIDELINES FOR 22
PREEXPOSURE PROPHYLAXIS. 23
(B) (1) A PHARMACIST MAY PRESCRIBE AN D DISPENSE A COMPLET E 24
COURSE OF PREEXPOSURE PROPHYLAXIS TO A PATIENT: 25
(I) UNDER GUIDELINES ESTA BLISHED BY THE BOARD 26
THROUGH REGULATION; 27
(II) IF THE PHARMACIST P ROVIDES COUNSELING T O THE 28
PATIENT ON THE USE OF PREEXPOSURE PROPHYLAXIS CONSISTENT WITH THE CDC 29
GUIDELINES FOR P REEXPOSURE PROPHYLAXIS , INCLUDING EDUCATION 30
REGARDING SIDE EFFEC TS, SAFETY DURING PREGNA NCY AND BREASTFEEDIN G, 31
ADHERENCE TO RECOMME NDED DOSING , AND THE IMPORTANCE O F TIMELY 32
TESTING AND TREATMENT, AS APPLICABLE, FOR HIV AND SEXUALLY TRANSMITTED 33
DISEASES; AND 34
HOUSE BILL 1114 5
(III) IF THE PHARMACIST PROVIDES: 1
1. NOTICE TO THE PATIENT’S PRIMARY CARE PROVIDER 2
OF THE PREEXPOSURE PROPHYLAXIS TREATMENT; OR 3
2. IF THE PATIENT DOES N OT HAVE A PRIMARY CA RE 4
PROVIDER OR REFUSES TO PROVIDE THE NAME OF A HEALTH CARE PROVIDER, THE 5
PATIENT WITH A LIST OF PHYSICIANS , CLINICS, OR OTHER HEALTH CARE 6
PROVIDERS IN THE ARE A, TO CONTACT REGARDING FOLLOW–UP CARE FOR 7
POSTEXPOSURE PROPHYLAXIS. 8
(2) A PHARMACIST MAY NOT ALLOW A PATIENT TO REFUSE OR WAIVE 9
A CONSULTATION REQUIRED UNDER PARAGRAPH (1) OF THIS SUBSECTION. 10
(C) (1) (I) BEFORE PRESCRIBING AN D DISPENSING P REEXPOSURE 11
PROPHYLAXIS TO A PAT IENT, A PHARMACIST SHALL C OMPLETE A TRAINING 12
PROGRAM APPROVED BY THE BOARD. 13
(II) THE TRAINING PROGRAM REQ UIRED UNDER 14
SUBPARAGRAPH (I) OF THIS PARAGRAPH SH ALL INCLUDE INFORMAT ION ABOUT 15
FINANCIAL ASSISTANCE PROGRAMS FOR PREEXPOSURE PROPHYLAXIS. 16
(2) THE BOARD SHALL CONSULT W ITH THE STATE BOARD OF 17
PHYSICIANS, THE STATE BOARD OF NURSING, AND OTHER RELEVANT 18
STAKEHOLDERS, INCLUDING THE MARYLAND CENTER FOR HIV CARE SERVICES, 19
WHEN DEVELOPING OR A PPROVING TRAINING PR OGRAMS THAT MEET THE 20
REQUIREMENTS OF THIS SUBSECTION. 21
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 22
as follows: 23
Article – Health – General 24
15–102.3. 25
(P) THE PROVISIONS OF § 15–858 OF THE INSURANCE ARTICLE APPLY TO 26
MANAGED CARE ORGANIZ ATIONS IN THE SAME M ANNER AS THEY APPLY TO 27
CARRIERS. 28
Article – Insurance 29
15–858. 30
(a) (1) This section applies to: 31
6 HOUSE BILL 1114
(i) insurers and nonprofit health service plans that provide coverage 1
for prescription drugs under individual, group, or blanket health insurance policies or 2
contracts that are issued or delivered in the State; and 3
(ii) health maintenance organizations tha t provide coverage for 4
prescription drugs under individual or group contracts that are issued or delivered in the 5
State. 6
(2) An insurer, a nonprofit health service plan, or a health maintenance 7
organization that provides coverage for prescription drugs through a pharmacy benefits 8
manager is subject to the requirements of this section. 9
(b) An entity subject to this section may not apply a prior authorization 10
requirement OR STEP THERAPY OR I MPOSE ANY COST –SHARING REQUIREMENTS , 11
INCLUDING COPAYMENTS, COINSURANCE, OR DEDUCTIBLES, for a prescription drug 12
used as PREEXPOSURE PROPHYLAXIS OR postexposure prophylaxis for the prevention of 13
HIV if the prescription drug is prescribed for use in accordance with Centers for Disease 14
Control and Prevention guidelines. 15
(C) AN ENTITY SUBJECT TO THIS SECTION MAY NOT IMPOSE ANY 16
COST–SHARING REQUIREMENTS , INCLUDING COPAYMENTS , COINSURANCE, OR 17
DEDUCTIBLES, FOR MEDICALLY NECESSARY AND APPROPRIATE SERVICES RELATED 18
TO THE USE OF PREEXP OSURE PROPHYLAXIS OR POSTEXPOSURE PROPHYL AXIS, 19
INCLUDING: 20
(1) HIV TESTING; 21
(2) KIDNEY FUNCTION TESTING; 22
(3) ONGOING FOLLOW–UP AND MONITORING EVERY 3 MONTHS; 23
(4) PREGNANCY TESTING; 24
(5) PROVIDER OFFICE AND TELEHEALTH VISITS FO R PRESCRIBING 25
AND MEDICATION MANAGEMENT; 26
(6) SEROLOGIC LABORATORY TESTING F OR HEPATITIS B AND 27
HEPATITIS C VIRUSES; 28
(7) TESTING FOR OTHER SE XUALLY TRANSMITTED I NFECTIONS, 29
INCLUDING THREE–SITE TESTING FOR GONORRHEA AND CHLAMYDIA; AND 30
(8) VACCINATIONS FOR HEPATITIS B. 31
HOUSE BILL 1114 7
SECTION 3. AND BE IT FURTHER ENACTED, That, on or before October 1, 2026, 1
the State Board of Pharmacy shall: 2
(1) develop a plan to ensure pharmacists throughout the State are notified 3
of the provisions of this Act and the training programs developed or approved under § 4
12–515(c) of the Health Occupations Article, as enacted by Section 1 of this Act; and 5
(2) establish a workgroup with relevant stakeholders to consider and make 6
recommendations to the General Assembly on collaborative practice agreements or a 7
statewide protocol under which pharmacists may assess patients, order labs, and prescribe 8
preexposure prophylaxis. 9
SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 10
effect January 1, 2027. 11
SECTION 5. AND BE IT FURTHER ENACTED, That, except as provided in Section 12
4 of this Act, this Act shall take effect July 1, 2026. 13