2023 -- S 0563 SUBSTITUTE A AS AMENDED
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LC001940/SUB A/2
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO INSURANCE -- INSURANCE COVERAGE FOR PREVENTION OF HIV
INFECTION
Introduced By: Senators Murray, Valverde, Lauria, Pearson, Euer, Lawson, Mack,
Acosta, Miller, and Cano
Date Introduced: March 07, 2023
Referred To: Senate 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 1
Insurance Policies" is hereby amended by adding thereto the following sections: 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. Each long-acting injectable drug with a different duration shall 9
constitute a separate method of administration. A health insurer is not required to cover any 10
preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 11
out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 12
pharmacy benefit. 13
(b) The healthcare benefits outlined in this chapter apply only to services delivered within 14
the health insurer’s provider network; provided that, all health insurers shall be required to provide 15
coverage for those benefits mandated by this chapter outside of the health insurer’s provider 16
network where it can be established that the required services are not available from a provider in 17
the health insurer’s network. 18
LC001940/SUB A/2 - Page 2 of 15
27-18-92. Expedited Prior Authorization. 1
To the extent a prior authorization is permitted and applied, then it shall be conducted in 2
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-3
18.9-6(a)(1). 4
27-18-93. Dispensing and Administration of HIV PrEP or PEP Drugs. 5
(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 6
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 7
subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 8
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 9
pursuant to a standing order or collaborative practice agreement or to protocols developed by the 10
board for when there is no prescription drug order, standing order or collaborative practice 11
agreement in accordance with the requirements in this subsection and may also order laboratory 12
testing for HIV infection as necessary. 13
(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 14
training program approved by the board on the use of protocols developed by the board for 15
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 16
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 17
to counsel patients prescribed an HIV prevention drug. 18
(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 19
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 20
(1) The patient tests negative for HIV infection, as documented by a negative HIV test 21
result obtained within the previous seven (7) days. If the patient does not provide evidence of a 22
negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 23
directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 24
If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 25
direct the patient to a primary care provider and provide a list of primary care providers and clinics 26
within a reasonable travel distance of the patient's residence; 27
(2) The patient does not report any signs or symptoms of acute HIV infection on a self-28
reporting checklist of acute HIV infection signs and symptoms; 29
(3) The patient does not report taking any contraindicated medications; 30
(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 31
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 32
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 33
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 34
LC001940/SUB A/2 - Page 3 of 15
PEP drug to a single patient once every two (2) years without a prescription; 1
(5) The pharmacist documents, to the extent possible, the services provided by the 2
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 3
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 4
patient; 5
(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 6
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 7
practitioner; and 8
(7) The pharmacist notifies the patient's primary care provider that the pharmacist 9
completed the requirements specified in this subsection. 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
(d) A pharmacist shall dispense or administer a complete course of a post-exposure 14
prophylaxis drug as long as all of the following conditions are met: 15
(1) The pharmacist screens the patient and determines that the exposure occurred within 16
the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 17
exposure prophylaxis drug under CDC guidelines; 18
(2) The pharmacist provides HIV testing to the patient or determines that the patient is 19
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 20
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 21
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 22
(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 23
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 24
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 25
(4) The pharmacist notifies the patient's primary care provider of the dispensing or 26
administering of the post-exposure prophylaxis drug. 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
(e) The board shall promulgate rules and regulations establishing standards for authorizing 31
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 32
section, including adequate training requirements and protocols for when there is no prescription 33
drug order, standing order or collaborative practice agreement. 34
LC001940/SUB A/2 - Page 4 of 15
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 1
Corporations" is hereby amended by adding thereto the following sections: 2
27-19-83. 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. Each long-acting injectable drug with a different duration shall 9
constitute a separate method of administration. A health insurer is not required to cover any 10
preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 11
out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 12
pharmacy benefit. 13
(b) The healthcare benefits outlined in this chapter apply only to services delivered within 14
the health insurer’s provider network; provided that, all health insurers shall be required to provide 15
coverage for those benefits mandated by this chapter outside of the health insurer’s provider 16
network where it can be established that the required services are not available from a provider in 17
the health insurer’s network. 18
27-19-84. Expedited Prior Authorization. 19
To the extent a prior authorization is permitted and applied, then it shall be conducted in 20
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-21
18.9-6(a)(1). 22
27-19-85. Dispensing and Administration of HIV PrEP or PEP Drugs. 23
(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 24
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 25
subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 26
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 27
pursuant to a standing order or collaborative practice agreement or to protocols developed by the 28
board for when there is no prescription drug order, standing order or collaborative practice 29
agreement in accordance with the requirements in this subsection and may also order laboratory 30
testing for HIV infection as necessary. 31
(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 32
training program approved by the board on the use of protocols developed by the board for 33
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 34
LC001940/SUB A/2 - Page 5 of 15
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 1
to counsel patients prescribed an HIV prevention drug. 2
(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 3
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 4
(1) The patient tests negative for HIV infection, as documented by a negative HIV test 5
result obtained within the previous seven (7) days. If the patient does not provide evidence of a 6
negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 7
directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 8
If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 9
direct the patient to a primary care provider and provide a list of primary care providers and clinics 10
within a reasonable travel distance of the patient's residence; 11
(2) The patient does not report any signs or symptoms of acute HIV infection on a self-12
reporting checklist of acute HIV infection signs and symptoms; 13
(3) The patient does not report taking any contraindicated medications; 14
(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 15
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 16
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 17
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 18
PEP drug to a single patient once every two (2) years without a prescription; 19
(5) The pharmacist documents, to the extent possible, the services provided by the 20
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 21
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 22
patient; 23
(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 24
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 25
practitioner; and 26
(7) The pharmacist notifies the patient's primary care provider that the pharmacist 27
completed the requirements specified in this subsection. If the patient does not have a primary care 28
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 29
provide the patient a list of physicians, clinics or other health care providers to contact regarding 30
follow-up care. 31
(d) A pharmacist shall dispense or administer a complete course of a post-exposure 32
prophylaxis drug as long as all of the following conditions are met: 33
(1) The pharmacist screens the patient and determines that the exposure occurred within 34
LC001940/SUB A/2 - Page 6 of 15
the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 1
exposure prophylaxis drug under CDC guidelines; 2
(2) The pharmacist provides HIV testing to the patient or determines that the patient is 3
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 4
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 5
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 6
(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 7
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 8
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 9
(4) The pharmacist notifies the patient's primary care provider of the dispensing or 10
administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 11
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 12
provide the patient a list of physicians, clinics or other health care providers to contact regarding 13
follow-up care. 14
(e) The board shall promulgate rules and regulations establishing standards for authorizing 15
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 16
section, including adequate training requirements and protocols for when there is no prescription 17
drug order, standing order or collaborative practice agreement. 18
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 19
Corporations" is hereby amended by adding thereto the following sections: 20
27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 21
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 22
(a) Every group health insurance contract, or every group hospital or medical expense 23
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 24
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 25
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 26
(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall 27
constitute a separate method of administration. A health insurer is not required to cover any 28
preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 29
out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 30
pharmacy benefit. 31
(b) The healthcare benefits outlined in this chapter apply only to services delivered within 32
the health insurer’s provider network; provided that, all health insurers shall be required to provide 33
coverage for those benefits mandated by this chapter outside of the health insurer’s provider 34
LC001940/SUB A/2 - Page 7 of 15
network where it can be established that the required services are not available from a provider in 1
the health insurer’s network. 2
27-20-80. Expedited Prior Authorization. 3
To the extent a prior authorization is permitted and applied, then it shall be conducted in 4
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant § 27-5
18.9-6(a)(1). 6
27-20-81. Dispensing and Administration of HIV PrEP or PEP Drugs. 7
(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 8
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 9
subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 10
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 11
of this section pursuant to a standing order or collaborative practice agreement or to protocols 12
developed by the board for when there is no prescription drug order, standing order or collaborative 13
practice agreement in accordance with the requirements in this subsection and may also order 14
laboratory testing for HIV infection as necessary. 15
(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 16
training program approved by the board on the use of protocols developed by the board for 17
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 18
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 19
to counsel patients prescribed an HIV prevention drug. 20
(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 21
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 22
(1) The patient tests negative for HIV infection, as documented by a negative HIV test 23
result obtained within the previous seven (7) days. If the patient does not provide evidence of a 24
negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 25
directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 26
If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 27
direct the patient to a primary care provider and provide a list of primary care providers and clinics 28
within a reasonable travel distance of the patient's residence; 29
(2) The patient does not report any signs or symptoms of acute HIV infection on a self-30
reporting checklist of acute HIV infection signs and symptoms; 31
(3) The patient does not report taking any contraindicated medications; 32
(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 33
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 34
LC001940/SUB A/2 - Page 8 of 15
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 1
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 2
PEP drug to a single patient once every two (2) years without a prescription; 3
(5) The pharmacist documents, to the extent possible, the services provided by the 4
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 5
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 6
patient; 7
(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 8
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 9
practitioner; and 10
(7) The pharmacist notifies the patient's primary care provider that the pharmacist 11
completed the requirements specified in this subsection. If the patient does not have a primary care 12
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 13
provide the patient a list of physicians, clinics or other health care providers to contact regarding 14
follow-up care. 15
(d) A pharmacist shall dispense or administer a complete course of a post-exposure 16
prophylaxis drug as long as all of the following conditions are met: 17
(1) The pharmacist screens the patient and determines that the exposure occurred within 18
the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 19
exposure prophylaxis drug under CDC guidelines; 20
(2) The pharmacist provides HIV testing to the patient or determines that the patient is 21
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 22
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 23
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 24
(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 25
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 26
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 27
(4) The pharmacist notifies the patient's primary care provider of the dispensing or 28
administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 29
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 30
provide the patient a list of physicians, clinics or other health care providers to contact regarding 31
follow-up care. 32
(e) The board shall promulgate rules and regulations establishing standards for authorizing 33
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 34
LC001940/SUB A/2 - Page 9 of 15
section, including adequate training requirements and protocols for when there is no prescription 1
drug order, standing order to collaborative practice agreement. 2
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 3
Organizations" is hereby amended by adding thereto the following sections: 4
27-41-96. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 5
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 6
(a) Every group health insurance contract, or every group hospital or medical expense 7
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 8
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 9
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 10
(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall 11
constitute a separate method of administration. A health insurer is not required to cover any 12
preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 13
out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 14
pharmacy benefit. 15
(b) The healthcare benefits outlined in this chapter apply only to services delivered within 16
the health insurer’s provider network; provided that, all health insurers shall be required to provide 17
coverage for those benefits mandated by this chapter outside of the health insurer’s provider 18
network where it can be established that the required services are not available from a provider in 19
the health insurer’s network. 20
27-41-97. Expedited Prior Authorization. 21
To the extent a prior authorization is permitted and applied, then it shall be conducted in 22
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-23
18.9-6(a)(1). 24
27-41-98. Dispensing and Administration of HIV PrEP or PEP Drugs. 25
(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 26
Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 27
subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 28
PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 29
pursuant to a standing order or collaborative practice agreement or to protocols developed by the 30
board for when there is no prescription drug order, standing order or collaborative practice 31
agreement in accordance with the requirements in this subsection and may also order laboratory 32
testing for HIV infection as necessary. 33
(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 34
LC001940/SUB A/2 - Page 10 of 15
training program approved by the board on the use of protocols developed by the board for 1
prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 2
laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 3
to counsel patients prescribed an HIV prevention drug. 4
(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 5
day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 6
(1) The patient tests negative for HIV infection, as documented by a negative HIV test 7
result obtained within the previous seven (7) days. If the patient does not provide evidence of a 8
negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 9
directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 10
If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 11
direct the patient to a primary care provider and provide a list of primary care providers and clinics 12
within a reasonable travel distance of the patient's residence; 13
(2) The patient does not report any signs or symptoms of acute HIV infection on a self-14
reporting checklist of acute HIV infection signs and symptoms; 15
(3) The patient does not report taking any contraindicated medications; 16
(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 17
the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 18
be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 19
that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 20
PEP drug to a single patient once every two (2) years without a prescription; 21
(5) The pharmacist documents, to the extent possible, the services provided by the 22
pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 23
The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 24
patient; 25
(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 26
PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 27
practitioner; and 28
(7) The pharmacist notifies the patient's primary care provider that the pharmacist 29
completed the requirements specified in this subsection. If the patient does not have a primary care 30
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 31
provide the patient a list of physicians, clinics or other health care providers to contact regarding 32
follow-up care. 33
(d) A pharmacist shall dispense or administer a complete course of a post-exposure 34
LC001940/SUB A/2 - Page 11 of 15
prophylaxis drug as long as all of the following conditions are met: 1
(1) The pharmacist screens the patient and determines that the exposure occurred within 2
the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 3
exposure prophylaxis drug under CDC guidelines; 4
(2) The pharmacist provides HIV testing to the patient or determines that the patient is 5
willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 6
HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 7
the pharmacist may dispense or administer a post-exposure prophylaxis drug; 8
(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 9
the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 10
availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 11
(4) The pharmacist notifies the patient's primary care provider of the dispensing or 12
administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 13
provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 14
provide the patient a list of physicians, clinics or other health care providers to contact regarding 15
follow-up care. 16
(e) The board shall promulgate rules and regulations establishing standards for authorizing 17
pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 18
section, including adequate training requirements and protocols for when there is no prescription 19
drug order, standing order or collaborative practice agreement. 20
SECTION 5. Section 23-6.3-2 of the General Laws in Chapter 23-6.3 entitled "Prevention 21
and Suppression of Contagious Diseases - HIV/AIDS" is hereby amended to read as follows: 22
23-6.3-2. Definitions. 23
As used in this chapter the following words shall have the following meanings: 24
(1) "Agent" means a person empowered by the patient to assert or waive the confidentiality, 25
or to disclose or consent to the disclosure of confidential information, as established by chapter 26
37.3 of title 5, as amended, entitled "Confidentiality of Health Care Communications and 27
Information Act." 28
(2) "AIDS" means the medical condition known as acquired immune deficiency syndrome, 29
caused by infection of an individual by the human immunodeficiency virus (HIV). 30
(3) "Anonymous HIV testing" means an HIV test that utilizes a laboratory generated code 31
based system, which does not require an individual's name or other identifying information that 32
may reveal one's identity, including information related to the individual's health insurance policy, 33
to be associated with the test. 34
LC001940/SUB A/2 - Page 12 of 15
(4) "Antibody" means a protein produced by the body in response to specific foreign 1
substances such as bacteria or viruses. 2
(5) "Community-based organization" means an entity that has written authorization from 3
the department for HIV counseling, testing and referral services (HIV CTRS). 4
(6) "Confidential HIV testing" means an HIV test that requires the individual's name and 5
other identifying information including information related to the individual's health insurance 6
policy, as appropriate. 7
(7) "Consent" means an explicit exchange of information between a person and a healthcare 8
provider or qualified professional HIV test counselor through which an informed individual can 9
choose whether to undergo HIV testing or decline to do so. Elements of consent shall include 10
providing each individual with verbal or written information regarding an explanation of HIV 11
infection, a description of interventions that can reduce HIV transmission, the meanings of positive 12
and negative test results, the voluntary nature of the HIV testing, an opportunity to ask questions 13
and to decline testing. 14
(8) "Controlled substance" means a drug, substance, or immediate precursor in schedules 15
I-V listed in the provisions of chapter 28 of title 21 entitled, "Uniform Controlled Substances Act." 16
(9) "Department" means the Rhode Island department of health. 17
(10) "Diagnosis of AIDS" means the most current surveillance case definition for AIDS 18
published in the Centers for Disease Control & Prevention (CDC). 19
(11) "Diagnosis of HIV" means the most current surveillance case definition for HIV 20
infection published in the CDC's (MMWR). 21
(12) "Director" means the director of the Rhode Island department of health. 22
(13) "ELISA result" means enzyme-linked immunosorbent assay or EIA (enzyme 23
immunoassay) which is a serologic technique used in immunology to detect the presence of either 24
antibody or antigen. 25
(14) "Health benefits" include accident and sickness, including disability or health 26
insurance, health benefit plans and/or policies, hospital, health, or medical service plans, or any 27
health maintenance organization plan pursuant to title 27 or otherwise. 28
(15) "Healthcare facility" means those facilities licensed by the department in accordance 29
with the provisions of chapter 17 of this title. 30
(16) "Healthcare provider," as used herein, means a licensed physician, physician assistant, 31
certified nurse practitioner, pharmacist or midwife. 32
(17) "Healthcare settings" means venues offering clinical STD services including, but not 33
limited to, hospitals, urgent care clinics, STD clinics and other substance abuse treatment facilities, 34
LC001940/SUB A/2 - Page 13 of 15
mental health treatment facilities, community health centers, primary care and OB/GYN physician 1
offices, and family planning providers. 2
(18) "HIV" means the human immunodeficiency virus, the pathogenic organism 3
responsible for HIV infection and/or the acquired immunodeficiency syndrome (AIDS) in humans. 4
(19) "HIV CD4 T-lymphocyte test result" means the results of any currently medically 5
accepted and/or FDA approved test used to count CD4 T-lymphatic cells in the blood of an HIV-6
infected person. 7
(20) "HIV counseling" means an interactive process of communication between a person 8
and a healthcare provider or qualified professional HIV test counselor during which there is an 9
assessment of the person's risks for HIV infection and the provision of counseling to assist the 10
person with behavior changes that can reduce risks for acquiring HIV infection. 11
(21) "HIV screening" means the conduct of HIV testing among those who do not show 12
signs or symptoms of an HIV infection. 13
(22) "HIV test" means any currently medically accepted and/or FDA approved test for 14
determining HIV infection in humans. 15
(23) "Occupational health representative" means a person, within a healthcare facility, 16
trained to respond to occupational, particularly blood borne, exposures. 17
(24) "Opts out" means that a person who has been notified that a voluntary HIV test will 18
be performed, has elected to decline or defer testing. Consent to HIV testing is inferred unless the 19
individual declines testing. 20
(25) "Perinatal case report for HIV" means the information that is provided to the 21
department related to a child aged less than eighteen (18) months born to an HIV-infected mother 22
and the child does not meet the criteria for HIV infection or the criteria for "not infected" with HIV 23
as defined in the most current surveillance case definition for HIV infection published by the CDC. 24
(26) "Person" means any individual, trust or estate, partnership, corporation (including 25
associations, joint stock companies), limited liability companies, state, or political subdivision or 26
instrumentality of a state. 27
(27) "Persons at high risk for HIV infection" means persons defined as being high risk in 28
the CDC's most current recommendations for HIV testing of adults, adolescents and pregnant 29
women in healthcare settings or through authority and responsibilities conferred on the director by 30
law in protecting the public's health. 31
(28) "Polymerase chain reaction (PCR) test" means a common laboratory method of 32
creating copies of specific fragments of DNA or RNA. 33
(29) "Qualified professional HIV test counselor" means: (i) A physician, physician 34
LC001940/SUB A/2 - Page 14 of 15
assistant, certified nurse practitioner, midwife, or nurse licensed to practice in accordance with 1
applicable state law; (ii) A medical student who is actively matriculating in a medical degree 2
program and who performs duties assigned to them by a physician; or (iii) A person who has 3
completed an HIV counseling training program, in accordance with regulations hereunder 4
promulgated. 5
(30) "Sexually transmitted diseases (STD's)" means those diseases included in § 23-11-1, 6
as amended, entitled "Sexually Transmitted Diseases," and any other sexually transmitted disease 7
that may be required to be reported by the department. 8
SECTION 6. This act shall take effect on January 1, 2024. 9
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LC001940/SUB A/2 - Page 15 of 15
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- INSURANCE COVERAGE FOR PREVENT ION OF HIV
INFECTION
***
This act would require coverage for the treatment of pre-exposure prophylaxis (PrEP) for 1
the prevention of HIV and post-exposure prophylaxis (PEP) for treatment of HIV infection, 2
commencing January 1, 2024. 3
This act would take effect on January 1, 2024. 4
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