PRINTER'S NO. 1281
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1213
Session of
2023
INTRODUCED BY KHAN, KENYATTA, KOSIEROWSKI, KRAJEWSKI, SCOTT,
PROBST, RABB, HOHENSTEIN, MADDEN, HANBIDGE, WAXMAN, ISAACSON,
SANCHEZ, BOROWSKI, PARKER, HILL-EVANS, SHUSTERMAN, ROZZI,
INNAMORATO, O'MARA, FLEMING, DELLOSO, McNEILL AND MAYES,
MAY 19, 2023
REFERRED TO COMMITTEE ON HEALTH, MAY 19, 2023
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
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medical services worker, advanced practice registered nurse or
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.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) The act of May 18, 1976 (P.L.123, No.54),
known as the Individual Accident and Sickness Insurance
Minimum Standards Act.
(iv) 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, limited benefit, credit, dental, vision, specified
disease, Medicare supplement, Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) supplement, long-
term care or disability income, workers' compensation or
automobile medical payment insurance.
"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
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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 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 delivered, issued
for delivery, renewed, extended or modified 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 cost-sharing 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 impose counseling by an infectious
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disease specialist or immunologist as a condition to receive PEP
or PrEP, or an associated laboratory service for monitoring,
visit to a health care provider or visit to a prescriber.
Section 4. Effective date.
This act shall take effect in 60 days.
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