Chapter 126
2024 -- H 7625 SUBSTITUTE A
Enacted 06/17/2024

A N   A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES -- INSURANCE COVERAGE FOR PREVENTION OF HIV INFECTION

Introduced By: Representatives Kislak, Shekarchi, McGaw, Solomon, Donovan, Boylan, Potter, Cruz, Giraldo, and Knight

Date Introduced: February 15, 2024

It is enacted by the General Assembly as follows:
     SECTION 1. Section 27-18-91 of the General Laws in Chapter 27-18 entitled "Accident
and Sickness Insurance Policies" is hereby amended to read as follows:
     27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective
January 1, 2024.]
     (a) Every group health insurance contract, or every group hospital or medical expense
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis
(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall
constitute a separate method of administration. A health insurer is not required to cover any pre-
exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-
of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network
pharmacy benefit.
     (b) The healthcare benefits outlined in this chaptersection apply only to services delivered
within the health insurer’s provider network; provided that, all health insurers shall be required to
provide coverage for those benefits mandated by this chaptersection outside of the health insurer’s
provider network where it can be established that the required services are not available from a
provider in the health insurer’s network.
     (c) A health insurer shall provide access to at least one pre-exposure (“PrEP”) drug in each
method of administration and at least one of the Centers for Disease Control and Prevention
preferred post-exposure (“PEP”) drug treatment regimen, without any prior authorization or step
therapy requirement. There shall be no copayment required, and no deductible shall need to be met,
to obtain the prescription covered by the contract, plan, or policy.
     SECTION 2. Section 27-18-92 of the General Laws in Chapter 27-18 entitled "Accident
and Sickness Insurance Policies" is hereby repealed.
     27-18-92. Expedited prior authorization. [Effective January 1, 2024.]
     To the extent a prior authorization is permitted and applied, then it shall be conducted in
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-
18.9-6(a)(1).
     SECTION 3. Section 27-19-83 of the General Laws in Chapter 27-19 entitled "Nonprofit
Hospital Service Corporations" is hereby amended to read as follows:
     27-19-83. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective
January 1, 2024.]
     (a) Every group health insurance contract, or every group hospital or medical expense
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis
(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall
constitute a separate method of administration. A health insurer is not required to cover any pre-
exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-
of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network
pharmacy benefit.
     (b) The healthcare benefits outlined in this chaptersection apply only to services delivered
within the health insurer’s provider network; provided that, all health insurers shall be required to
provide coverage for those benefits mandated by this chaptersection outside of the health insurer’s
provider network where it can be established that the required services are not available from a
provider in the health insurer’s network.
     (c) A health insurer shall provide access to at least one pre-exposure (“PrEP”) drug in each
method of administration and at least one of the Centers for Disease Control and Prevention
preferred post-exposure (“PEP”) drug treatment regimen, without any prior authorization or step
therapy requirement. There shall be no copayment required, and no deductible shall need to be met,
to obtain the prescription covered by the contract, plan, or policy.
     SECTION 4. Section 27-19-84 of the General Laws in Chapter 27-19 entitled "Nonprofit
Hospital Service Corporations" is hereby repealed.
     27-19-84. Expedited prior authorization. [Effective January 1, 2024.]
     To the extent a prior authorization is permitted and applied, then it shall be conducted in
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-
18.9-6(a)(1).
     SECTION 5. Section 27-20-79 of the General Laws in Chapter 27-20 entitled "Nonprofit
Medical Service Corporations" is hereby amended to read as follows:
     27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective
January 1, 2024.]
     (a) Every group health insurance contract, or every group hospital or medical expense
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis
(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall
constitute a separate method of administration. A health insurer is not required to cover any pre-
exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-
of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network
pharmacy benefit.
     (b) The healthcare benefits outlined in this chaptersection apply only to services delivered
within the health insurer’s provider network; provided that, all health insurers shall be required to
provide coverage for those benefits mandated by this chaptersection outside of the health insurer’s
provider network where it can be established that the required services are not available from a
provider in the health insurer’s network.
     (c) A health insurer shall provide access to at least one pre-exposure (“PrEP”) drug in each
method of administration and at least one of the Centers for Disease Control and Prevention
preferred post-exposure (“PEP”) drug treatment regimen, without any prior authorization or step
therapy requirement. There shall be no copayment required, and no deductible shall need to be met,
to obtain the prescription covered by the contract, plan, or policy.
     SECTION 6. Section 27-20-80 of the General Laws in Chapter 27-20 entitled "Nonprofit
Medical Service Corporations" is hereby repealed.
     27-20-80. Expedited prior authorization. [Effective January 1, 2024.]
     To the extent a prior authorization is permitted and applied, then it shall be conducted in
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant § 27-
18.9-6(a)(1).
     SECTION 7. Section 27-41-96 of the General Laws in Chapter 27-41 entitled "Health
Maintenance Organizations" is hereby amended to read as follows:
     27-41-96. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the
prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective
January 1, 2024.]
     (a) Every group health insurance contract, or every group hospital or medical expense
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of
pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis
(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall
constitute a separate method of administration. A health insurer is not required to cover any pre-
exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-
of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network
pharmacy benefit.
     (b) The healthcare benefits outlined in this chaptersection apply only to services delivered
within the health insurer’s provider network; provided that, all health insurers shall be required to
provide coverage for those benefits mandated by this chaptersection outside of the health insurer’s
provider network where it can be established that the required services are not available from a
provider in the health insurer’s network.
     (c) A health insurer shall provide access to at least one pre-exposure (“PrEP”) drug in each
method of administration and at least one of the Centers for Disease Control and Prevention
preferred post-exposure (“PEP”) drug treatment regimen, without any prior authorization or step
therapy requirement. There shall be no copayment required, and no deductible shall need to be met,
to obtain the prescription covered by the contract, plan, or policy.
     SECTION 8. Section 27-41-97 of the General Laws in Chapter 27-41 entitled "Health
Maintenance Organizations" is hereby repealed.
     27-41-97. Expedited prior authorization. [Effective January 1, 2024.]
     To the extent a prior authorization is permitted and applied, then it shall be conducted in
an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-
18.9-6(a)(1).
     SECTION 9. This act shall take effect on January 1, 2025.
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LC004981/SUB A
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