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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
House Bill 2292
Sponsored by Representative GRAYBER; Representatives MCDONALD, NELSON, PHAM H, Senator PHAM K
(Presessionfiled.)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure as introduced.The statement includes a measure digest written in compliance with applicable readability
standards.
Digest: Tells some health insurers and Medicaid plans to cover more drugs and treatment for
HIV. (Flesch Readability Score:73.1).
Requires health benefit plans and medical assistance managed plans to provide coverage with
no cost-sharing for additional treatment for human immunodeficiency virus and prohibits requiring
prior authorization.
A BILL FOR AN ACT
Relating to treatment of human immunodeficiency virus; creating new provisions; and amending ORS
743B.425.
Be It Enacted by the People of the State of Oregon:
SECTION 1. Section 2 of this 2025 Act is added to and made a part of the Insurance Code.
SECTION 2.(1) An insurer that offers a health benefit plan, as defined in ORS 743B.005,
that reimburses the cost of counseling, prevention services or screening for sexually trans-
mitted infections, shall provide coverage for human immunodeficiency virus prevention drugs
and services necessary for the commencement and continuation of human immunodeficiency
virus prevention drugs, including but not limited to office visits, testing, vaccinations and
monitoringservices.
(2) The coverage must be provided without any cost-sharing, coinsurance or deductible
applicable to the services.
(3) This section is exempt from ORS 743A.001.
SECTION 3. ORS 743B.425 is amended to read:
743B.425. (1) An insurer offering a health benefit plan as defined in ORS 743B.005 may not:
(a) Require prior authorization:
(A) During the first 60 days of treatment, including medication therapy, prescribed for opioid
or opiate withdrawal; or
(B) For post-exposure prophylactic antiretroviral drugs or therapies or [at least one] preexpo-
sure prophylactic antiretroviral [drug] drugs;
(b) Restrict the reimbursement for medication therapies, preexposure prophylactic antiretroviral
drugs or post-exposure prophylactic antiretroviral drugs to in-network pharmacists or pharmacies;
or
(c) Subject to ORS 742.008, require a deductible, copayment, coinsurance or other cost-sharing,
or impose an annual or lifetime benefit limit for the coverage of human immunodeficiency virus
post-exposure prophylactic drugs or therapies prescribed following a possible exposure to human
immunodeficiencyvirus.
NOTE:Matter in boldfaced type in an amended section is new; matter [italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
LC 1678 HB2292
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(2) This section is not subject to ORS 743A.001.
(3) This section does not prohibit prior authorization for opioids or opiates prescribed for pur-
poses other than medication therapy or treatment of opioid or opiate abuse or addiction.
(4) Subsection (1)(b) of this section does not apply to a health maintenance organization as de-
fined in ORS 750.005.
SECTION 4. Section 5 of this 2025 Act is added to and made a part of ORS chapter 414.
SECTION 5.(1) As used in this section:
(a) “Prior authorization” has the meaning given that term in ORS 743B.001.
(b) “Step therapy” has the meaning given that term in ORS 743B.001.
(2) Notwithstanding ORS 414.325, the Oregon Health Authority and a coordinated care
organization may not require prior authorization or step therapy for drugs prescribed for a
medical assistance recipient for the treatment or prevention of human immunodeficiency
virusif:
(a) The drug has been approved by the United States Food and Drug Administration for
the treatment or prevention of human immunodeficiency virus; and
(b) The prescribing provider has determined that the drug is medically necessary.
(3) Nothing in this section prevents the authority from performing drug utilization review
that may be necessary for patient safety or for ensuring the prescribed drug is medically
accepted as required by section 1927 of the Social Security Act of 1935 (42 U.S.C. 1396r-8).
SECTION 6. Section 2 of this 2025 Act and the amendments to ORS 743B.425 by section
3 of this 2025 Act apply to health benefit plans offered, renewed or extended on or after the
effective date of this 2025 Act.
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