PRINTER'S NO. 1495
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.1301
Session of
2025
INTRODUCED BY KHAN, KENYATTA, KOSIEROWSKI, KRAJEWSKI, SCOTT,
GIRAL, SANCHEZ, GUENST, HANBIDGE, PIELLI, MALAGARI, MAYES,
HOHENSTEIN, CEPEDA-FREYTIZ, STEELE, HILL-EVANS, OTTEN, GREEN,
DALEY, BOROWSKI AND CARROLL, APRIL 28, 2025
REFERRED TO COMMITTEE ON HEALTH, APRIL 28, 2025
AN ACT
Requiring health insurance policies to provide coverage for pre-
exposure prophylaxis and post-exposure prophylaxis HIV
medication and associated laboratory tests and patient
visits.
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 and PEP
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 care provider." A licensed hospital or health care
facility or a person licensed, certified or otherwise regulated
to provide health care services under the laws of this
Commonwealth, including a physician, psychologist, emergency
medical services worker, advanced practice registered nurse or
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18 physician's assistant.
"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
contract or plan that provides medical or health care
coverage by a health care provider on an expense-incurred
service or prepaid basis that is offered by or is governed
under any of the following:
(i) The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, including section
630 of that act.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health
services plan corporations).
(2) The term does not include accident only, fixed
indemnity, hospital indemnity, limited benefit, credit,
dental, vision, specified disease, Medicare supplement, long-
term care, disability income, workers' compensation,
automobile medical payment insurance or a policy under which
benefits are provided by the Federal Government to active or
former military personnel and their dependents.
"HIV." The human immunodeficiency virus.
"PEP." A post-exposure prophylaxis HIV medication that is
approved by the United States Food and Drug Administration and
that can be taken as a prophylaxis to prevent the transmission
of the human immunodeficiency virus after a person is exposed.
"PrEP." A pre-exposure prophylaxis HIV medication that is
approved by the United States Food and Drug Administration and
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30 that can be taken as a prophylaxis to prevent the transmission
of the human immunodeficiency virus before a person is exposed.
"Prescriber." A person licensed, registered or otherwise
lawfully authorized to distribute, dispense or administer
medication.
Section 3. Mandated coverage.
(a) Requirements.--
(1) A health insurance policy that is offered, issued or
renewed in this Commonwealth on or after the effective date
of this subsection shall provide coverage for all the
expenses associated with PEP and PrEP, including the costs of
associated laboratory tests, patient visits to a health care
provider for the purpose of HIV medication counseling and
patient visits to a prescriber to have PEP and PrEP
prescribed or maintained.
(2) A patient shall not incur any copay, coinsurance,
deductible or other costsharing for any of the expenses
associated with PEP and PrEP, including the costs of
associated laboratory tests, patient visits to a health care
provider for the purpose of HIV medication counseling and
patient visits to a prescriber to have PEP or PrEP prescribed
or maintained.
(b) Specialty tier.--A provider of a health insurance policy
may not move a PEP or PrEP, or an associated laboratory service
for monitoring, visit to a health care provider or visit to a
prescriber, into a specialty tier solely for monetary gain.
(c) Counseling.--Unless medically necessary, a health
insurance policy shall not require counseling by an infectious
disease specialist or immunologist as a condition to receive PEP
or PrEP, or an associated laboratory service for monitoring,
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30 visit to a health care provider or visit to a prescriber.
Section 4. Applicability.
This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this paragraph.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this paragraph.
Section 5. Effective date.
This act shall take effect in 60 days.
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