2023 -- H 6150 SUBSTITUTE A
========
LC002548/SUB A
========
S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Representatives Potter, Baginski, Kazarian, Cruz, Donovan, Kislak,
Giraldo, McNamara, Voas, and Morales
Date Introduced: March 10, 2023
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
Policies" is hereby amended by adding thereto the following section: 2
27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 3
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 4
(a) Every group health insurance contract, or every group hospital or medical expense 5
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 6
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 7
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 8
(“PEP”) to prevent HIV infection. 9
(b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive 10
Services Taskforce, then the coverage shall be provided without applying any copayments, 11
deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in 12
accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and 13
guidance. 14
(c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 15
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 16
subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 17
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a) 18
of this section pursuant to a standing order or collaborative practice agreement or to protocols 19
LC002548/SUB A - Page 2 of 11
developed by the board for when there is no prescription drug order, standing order or collaborative 1
practice agreement in accordance with the requirements in this subsection and may also order 2
laboratory testing for HIV infection as necessary. 3
(1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 4
training program approved by the board on the use of protocols developed by the board for 5
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 6
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 7
to counsel patients prescribed an HIV prevention drug. 8
(2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 9
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 10
(i) The patient tests negative for HIV infection, as documented by a negative HIV test result 11
obtained within the previous seven (7) days. If the patient does not provide evidence of a negative 12
HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly 13
to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the 14
patient tests positive for HIV infection, the pharmacist or person administering the test shall direct 15
the patient to a primary care provider and provide a list of primary care providers and clinics within 16
a reasonable travel distance of the patient's residence; 17
(ii) The patient does not report any signs or symptoms of acute HIV infection on a self-18
reporting checklist of acute HIV infection signs and symptoms; 19
(iii) The patient does not report taking any contraindicated medications; 20
(iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 21
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 22
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 23
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 24
PEP drug to a single patient once every two (2) years without a prescription; 25
(v) The pharmacist documents, to the extent possible, the services provided by the 26
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 27
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 28
patient; 29
(vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 30
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 31
practitioner; and 32
(vii) The pharmacist notifies the patient's primary care provider that the pharmacist 33
completed the requirements specified in this subsection. If the patient does not have a primary care 34
LC002548/SUB A - Page 3 of 11
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 1
provide the patient a list of physicians, clinics or other health care providers to contact regarding 2
follow-up care. 3
(3) A pharmacist shall dispense or administer a complete course of a post-exposure 4
prophylaxis drug as long as all of the following conditions are met: 5
(i) The pharmacist screens the patient and determines that the exposure occurred within the 6
previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post- 7
exposure prophylaxis drug under CDC guidelines; 8
(ii) The pharmacist provides HIV testing to the patient or determines that the patient is 9
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 10
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 11
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 12
(iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 13
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 14
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 15
(iv) The pharmacist notifies the patient's primary care provider of the dispensing or 16
administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 17
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 18
provide the patient a list of physicians, clinics or other health care providers to contact regarding 19
follow-up care. 20
(4) The board shall promulgate rules and regulations establishing standards for authorizing 21
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 22
section, including adequate training requirements and protocols for when there is no prescription 23
drug order, standing order or collaborative practice agreement. 24
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 25
Corporations" is hereby amended by adding thereto the following section: 26
27-19-83. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 27
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 28
(a) Every group health insurance contract, or every group hospital or medical expense 29
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 30
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 31
pre- exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 32
(“PEP”) to prevent HIV infection. 33
(b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive 34
LC002548/SUB A - Page 4 of 11
Services Taskforce, then the coverage shall be provided without applying any copayments, 1
deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in 2
accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and 3
guidance. 4
(c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 5
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 6
subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 7
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a) 8
of this section pursuant to a standing order or collaborative practice agreement or to protocols 9
developed by the board for when there is no prescription drug order, standing order or collaborative 10
practice agreement in accordance with the requirements in this subsection and may also order 11
laboratory testing for HIV infection as necessary. 12
(1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 13
training program approved by the board on the use of protocols developed by the board for 14
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 15
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 16
to counsel patients prescribed an HIV prevention drug. 17
(2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 18
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 19
(i) The patient tests negative for HIV infection, as documented by a negative HIV test result 20
obtained within the previous seven (7) days. If the patient does not provide evidence of a negative 21
HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly 22
to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the 23
patient tests positive for HIV infection, the pharmacist or person administering the test shall direct 24
the patient to a primary care provider and provide a list of primary care providers and clinics within 25
a reasonable travel distance of the patient's residence; 26
(ii) The patient does not report any signs or symptoms of acute HIV infection on a self-27
reporting checklist of acute HIV infection signs and symptoms; 28
(iii) The patient does not report taking any contraindicated medications; 29
(iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 30
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 31
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 32
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 33
PEP drug to a single patient once every two (2) years without a prescription; 34
LC002548/SUB A - Page 5 of 11
(v) The pharmacist documents, to the extent possible, the services provided by the 1
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 2
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 3
patient; 4
(vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 5
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 6
practitioner; and 7
(vii) The pharmacist notifies the patient's primary care provider that the pharmacist 8
completed the requirements specified in this subsection. If the patient does not have a primary care 9
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 10
provide the patient a list of physicians, clinics or other health care providers to contact regarding 11
follow-up care. 12
(3) A pharmacist shall dispense or administer a complete course of a post-exposure 13
prophylaxis drug as long as all of the following conditions are met: 14
(i) The pharmacist screens the patient and determines that the exposure occurred within the 15
previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-16
exposure prophylaxis drug under CDC guidelines; 17
(ii) The pharmacist provides HIV testing to the patient or determines that the patient is 18
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 19
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 20
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 21
(iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 22
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 23
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 24
(iv) The pharmacist notifies the patient's primary care provider of the dispensing or 25
administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 26
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 27
provide the patient a list of physicians, clinics or other health care providers to contact regarding 28
follow-up care. 29
(4) The board shall promulgate rules and regulations establishing standards for authorizing 30
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 31
section, including adequate training requirements and protocols for when there is no prescription 32
drug order, standing order or collaborative practice agreement. 33
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 34
LC002548/SUB A - Page 6 of 11
Corporations" is hereby amended by adding thereto the following section: 1
27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 2
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 3
(a) Every group health insurance contract, or every group hospital or medical expense 4
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 5
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 6
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 7
(“PEP”) to prevent HIV infection. 8
(b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive 9
Services Taskforce, then the coverage shall be provided without applying any copayments, 10
deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in 11
accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and 12
guidance. 13
(c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 14
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 15
subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 16
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a) 17
of this section pursuant to a standing order or collaborative practice agreement or to protocols 18
developed by the board for when there is no prescription drug order, standing order or collaborative 19
practice agreement in accordance with the requirements in this subsection and may also order 20
laboratory testing for HIV infection as necessary. 21
(1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 22
training program approved by the board on the use of protocols developed by the board for 23
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 24
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 25
to counsel patients prescribed an HIV prevention drug. 26
(2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 27
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 28
(i) The patient tests negative for HIV infection, as documented by a negative HIV test result 29
obtained within the previous seven (7) days. If the patient does not provide evidence of a negative 30
HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly 31
to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the 32
patient tests positive for HIV infection, the pharmacist or person administering the test shall direct 33
the patient to a primary care provider and provide a list of primary care providers and clinics within 34
LC002548/SUB A - Page 7 of 11
a reasonable travel distance of the patient's residence; 1
(ii) The patient does not report any signs or symptoms of acute HIV infection on a self-2
reporting checklist of acute HIV infection signs and symptoms; 3
(iii) The patient does not report taking any contraindicated medications; 4
(iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 5
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 6
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 7
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 8
PEP drug to a single patient once every two (2) years without a prescription; 9
(v) The pharmacist documents, to the extent possible, the services provided by the 10
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 11
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 12
patient; 13
(vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 14
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 15
practitioner; and 16
(vii) The pharmacist notifies the patient's primary care provider that the pharmacist 17
completed the requirements specified in this subsection. If the patient does not have a primary care 18
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 19
provide the patient a list of physicians, clinics or other health care providers to contact regarding 20
follow-up care. 21
(3) A pharmacist shall dispense or administer a complete course of a post-exposure 22
prophylaxis drug as long as all of the following conditions are met: 23
(i) The pharmacist screens the patient and determines that the exposure occurred within the 24
previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-25
exposure prophylaxis drug under CDC guidelines; 26
(ii) The pharmacist provides HIV testing to the patient or determines that the patient is 27
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 28
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 29
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 30
(iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 31
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 32
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 33
(iv) The pharmacist notifies the patient's primary care provider of the dispensing or 34
LC002548/SUB A - Page 8 of 11
administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 1
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 2
provide the patient a list of physicians, clinics or other health care providers to contact regarding 3
follow-up care. 4
(d) The board shall promulgate rules and regulations establishing standards for authorizing 5
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 6
section, including adequate training requirements and protocols for when there is no prescription 7
drug order, standing order or collaborative practice agreement. 8
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 9
Organizations" is hereby amended by adding thereto the following section: 10
27-41-96. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 11
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 12
(a) Every group health insurance contract, or every group hospital or medical expense 13
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 14
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 15
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 16
(“PEP”) to prevent HIV infection. 17
(b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive 18
Services Taskforce, then the coverage shall be provided without applying any copayments, 19
deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in 20
accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and 21
guidance. 22
(c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 23
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 24
subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 25
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a) 26
of this section pursuant to a standing order or collaborative practice agreement or to protocols 27
developed by the board for when there is no prescription drug order, standing order or collaborative 28
practice agreement in accordance with the requirements in this subsection and may also order 29
laboratory testing for HIV infection as necessary. 30
(1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 31
training program approved by the board on the use of protocols developed by the board for 32
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 33
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 34
LC002548/SUB A - Page 9 of 11
to counsel patients prescribed an HIV prevention drug. 1
(2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 2
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 3
(i) The patient tests negative for HIV infection, as documented by a negative HIV test result 4
obtained within the previous seven (7) days. If the patient does not provide evidence of a negative 5
HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly 6
to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the 7
patient tests positive for HIV infection, the pharmacist or person administering the test shall direct 8
the patient to a primary care provider and provide a list of primary care providers and clinics within 9
a reasonable travel distance of the patient's residence; 10
(ii) The patient does not report any signs or symptoms of acute HIV infection on a self-11
reporting checklist of acute HIV infection signs and symptoms; 12
(iii) The patient does not report taking any contraindicated medications; 13
(iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 14
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 15
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 16
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 17
PEP drug to a single patient once every two (2) years without a prescription; 18
(v) The pharmacist documents, to the extent possible, the services provided by the 19
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 20
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 21
patient; 22
(vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 23
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 24
practitioner; and 25
(vii) The pharmacist notifies the patient's primary care provider that the pharmacist 26
completed the requirements specified in this subsection. If the patient does not have a primary care 27
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 28
provide the patient a list of physicians, clinics or other health care providers to contact regarding 29
follow-up care. 30
(3) A pharmacist shall dispense or administer a complete course of a post-exposure 31
prophylaxis drug as long as all of the following conditions are met: 32
(i) The pharmacist screens the patient and determines that the exposure occurred within the 33
previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-34
LC002548/SUB A - Page 10 of 11
exposure prophylaxis drug under CDC guidelines; 1
(ii) The pharmacist provides HIV testing to the patient or determines that the patient is 2
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 3
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 4
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 5
(iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 6
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 7
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 8
(iv) The pharmacist notifies the patient's primary care provider of the dispensing or 9
administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 10
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 11
provide the patient a list of physicians, clinics or other health care providers to contact regarding 12
follow-up care. 13
(4) The board shall promulgate rules and regulations establishing standards for authorizing 14
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 15
section, including adequate training requirements and protocols for when there is no prescription 16
drug order, standing order or collaborative practice agreement. 17
SECTION 5. This act shall take effect upon passage. 18
========
LC002548/SUB A
========
LC002548/SUB A - Page 11 of 11
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would require health insurance coverage for the treatment of pre-exposure 1
prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV 2
infection, commencing January 1, 2024. This act would also direct the board of pharmacy to 3
promulgate rules and regulations establishing standards for authorizing pharmacists to prescribe, 4
dispense and administer HIV prevention drugs in accordance with this section, including adequate 5
training requirements and protocols for when there is no prescription drug order, standing order or 6
collaborative practice agreement. 7
This act would take effect upon passage. 8
========
LC002548/SUB A
========