PRINTER'S NO. 579
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
617
Session of
2021
INTRODUCED BY SIMS, HILL-EVANS, SANCHEZ, N. NELSON, FRANKEL,
SCHLOSSBERG, KRAJEWSKI, ISAACSON, FIEDLER, HOHENSTEIN, LEE,
KENYATTA, SCHWEYER, GUENST, WEBSTER, McCLINTON, MADDEN AND
T. DAVIS, FEBRUARY 24, 2021
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 24, 2021
AN ACT
Requiring health insurance policies to provide coverage for
preexposure prophylaxis HIV medication.
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 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 insurance policy." An individual or group health
insurance policy, contract or plan that provides medical or
health care coverage by a health care facility or licensed
health care provider on an expense-incurred service or prepaid
basis that is offered by or is governed under any of the
following:
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(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
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.
"Preexposure prophylaxis HIV medication." A medication that
is approved by the United States Food and Drug Administration
that can be taken as a prophylaxis to prevent the transmission
of the human immunodeficiency virus.
Section 3. Mandated coverage.
(a) General rule.--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 section
shall provide coverage for the expenses of a preexposure
prophylaxis HIV medication.
(b) Specialty tier.--Insurance providers may not move any
preexposure prophylaxis HIV medication into a specialty tier
solely for monetary gains.
(c) Counseling.--No health care plan may impose counseling
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from an infectious disease specialist or immunologist in order
to receive preexposure prophylaxis HIV medication unless
medically necessary.
Section 4. Effective date.
This act shall take effect in 60 days.
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