An Act requiring health insurance policies to provide coverage for preexposure prophylaxis HIV medication.

PRINTER'S NO. 1059
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 935
Session of
2025
INTRODUCED BY MUTH, HUGHES, KEARNEY, HAYWOOD, SAVAL,
CAPPELLETTI, COLLETT, FONTANA, TARTAGLIONE, COMITTA AND
SANTARSIERO, JULY 22, 2025
REFERRED TO BANKING AND INSURANCE, JULY 22, 2025
AN ACT
Requiring health insurance policies to provide coverage for
preexposure prophylaxis HIV medication.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the PrEP for
Pennsylvania Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Health insurance policy." An individual or group health
insurance policy, contract or plan that provides medical or
health care coverage by a health care facility or licensed
health care provider on an expense-incurred service or prepaid
basis that is offered by or is governed under any of the
following:
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(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
The term does not include accident only, fixed indemnity,
limited benefit, credit, dental, vision, specified disease,
Medicare supplement, Civilian Health and Medical Program of the
Uniformed Services supplement, long-term care or disability
income, workers' compensation or automobile medical payment
insurance.
"Insurance provider." An entity that issues a health
insurance policy.
"Preexposure prophylaxis HIV medication." A medication that
is approved by the United States Food and Drug Administration
that can be taken as a prophylaxis to prevent the transmission
of the human immunodeficiency virus.
Section 3. Mandated coverage.
(a) General rule.--A health insurance policy that is
delivered, issued for delivery, renewed, extended or modified in
this Commonwealth on or after the effective date of this section
shall provide coverage for the expenses of a preexposure
prophylaxis HIV medication.
(b) Specialty tier.--An insurance provider may not move a
preexposure prophylaxis HIV medication into a specialty tier
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solely for monetary gains.
(c) Counseling.--A health insurance policy may not impose
counseling from an infectious disease specialist or immunologist
in order to receive preexposure prophylaxis HIV medication
unless medically necessary.
Section 4. Effective date.
This act shall take effect in 60 days.
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