2023 -- H 6150 SUBSTITUTE A

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LC002548/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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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

Policies" is hereby amended by adding thereto the following section:

     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.

      (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.

     (b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive

Services Taskforce, then the coverage shall be provided without applying any copayments,

deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in

accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and

guidance.

     (c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a)

of this section pursuant to a standing order or collaborative practice agreement or to protocols

developed by the board for when there is no prescription drug order, standing order or collaborative

practice agreement in accordance with the requirements in this subsection and may also order

laboratory testing for HIV infection as necessary.

     (1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

to counsel patients prescribed an HIV prevention drug.

     (2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (i) The patient tests negative for HIV infection, as documented by a negative HIV test result

obtained within the previous seven (7) days. If the patient does not provide evidence of a negative

HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly

to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the

patient tests positive for HIV infection, the pharmacist or person administering the test shall direct

the patient to a primary care provider and provide a list of primary care providers and clinics within

a reasonable travel distance of the patient's residence;

     (ii) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (iii) The patient does not report taking any contraindicated medications;

     (iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

PEP drug to a single patient once every two (2) years without a prescription;

     (v) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (vii) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

LC002548/SUB A - Page 2 of 11

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (3) A pharmacist shall dispense or administer a complete course of a post-exposure

prophylaxis drug as long as all of the following conditions are met:

     (i) The pharmacist screens the patient and determines that the exposure occurred within the

previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-

exposure prophylaxis drug under CDC guidelines;

     (ii) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (iv) The pharmacist notifies the patient's primary care provider of the dispensing or

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (4) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order or collaborative practice agreement.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     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.

     (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.

     (b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive

LC002548/SUB A - Page 3 of 11

Services Taskforce, then the coverage shall be provided without applying any copayments,

deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in

accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and

guidance.

     (c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a)

of this section pursuant to a standing order or collaborative practice agreement or to protocols

developed by the board for when there is no prescription drug order, standing order or collaborative

practice agreement in accordance with the requirements in this subsection and may also order

laboratory testing for HIV infection as necessary.

     (1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

to counsel patients prescribed an HIV prevention drug.

     (2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (i) The patient tests negative for HIV infection, as documented by a negative HIV test result

obtained within the previous seven (7) days. If the patient does not provide evidence of a negative

HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly

to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the

patient tests positive for HIV infection, the pharmacist or person administering the test shall direct

the patient to a primary care provider and provide a list of primary care providers and clinics within

a reasonable travel distance of the patient's residence;

     (ii) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (iii) The patient does not report taking any contraindicated medications;

     (iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

PEP drug to a single patient once every two (2) years without a prescription;

LC002548/SUB A - Page 4 of 11

     (v) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (vii) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (3) A pharmacist shall dispense or administer a complete course of a post-exposure

prophylaxis drug as long as all of the following conditions are met:

     (i) The pharmacist screens the patient and determines that the exposure occurred within the

previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-

exposure prophylaxis drug under CDC guidelines;

     (ii) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (iv) The pharmacist notifies the patient's primary care provider of the dispensing or

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (4) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order or collaborative practice agreement.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

LC002548/SUB A - Page 5 of 11

Corporations" is hereby amended by adding thereto the following section:

     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.

     (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.

     (b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive

Services Taskforce, then the coverage shall be provided without applying any copayments,

deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in

accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and

guidance.

     (c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a)

of this section pursuant to a standing order or collaborative practice agreement or to protocols

developed by the board for when there is no prescription drug order, standing order or collaborative

practice agreement in accordance with the requirements in this subsection and may also order

laboratory testing for HIV infection as necessary.

     (1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

to counsel patients prescribed an HIV prevention drug.

     (2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (i) The patient tests negative for HIV infection, as documented by a negative HIV test result

obtained within the previous seven (7) days. If the patient does not provide evidence of a negative

HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly

to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the

patient tests positive for HIV infection, the pharmacist or person administering the test shall direct

the patient to a primary care provider and provide a list of primary care providers and clinics within

LC002548/SUB A - Page 6 of 11

a reasonable travel distance of the patient's residence;

     (ii) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (iii) The patient does not report taking any contraindicated medications;

     (iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

PEP drug to a single patient once every two (2) years without a prescription;

     (v) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (vii) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (3) A pharmacist shall dispense or administer a complete course of a post-exposure

prophylaxis drug as long as all of the following conditions are met:

     (i) The pharmacist screens the patient and determines that the exposure occurred within the

previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-

exposure prophylaxis drug under CDC guidelines;

     (ii) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (iv) The pharmacist notifies the patient's primary care provider of the dispensing or

LC002548/SUB A - Page 7 of 11

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (d) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order or collaborative practice agreement.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     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.

     (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.

     (b) When PrEP or PEP is recommended with a grade of “A” or “B” by the U.S. Preventive

Services Taskforce, then the coverage shall be provided without applying any copayments,

deductibles, coinsurance, or other cost sharing, and medical management shall be limited, in

accordance with the processes outlined in 42 U.S.C. § 300gg-13 and related regulations and

guidance.

     (c) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (d) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in subsection (a)

of this section pursuant to a standing order or collaborative practice agreement or to protocols

developed by the board for when there is no prescription drug order, standing order or collaborative

practice agreement in accordance with the requirements in this subsection and may also order

laboratory testing for HIV infection as necessary.

     (1) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

LC002548/SUB A - Page 8 of 11

to counsel patients prescribed an HIV prevention drug.

     (2) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (i) The patient tests negative for HIV infection, as documented by a negative HIV test result

obtained within the previous seven (7) days. If the patient does not provide evidence of a negative

HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly

to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. If the

patient tests positive for HIV infection, the pharmacist or person administering the test shall direct

the patient to a primary care provider and provide a list of primary care providers and clinics within

a reasonable travel distance of the patient's residence;

     (ii) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (iii) The patient does not report taking any contraindicated medications;

     (iv) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

PEP drug to a single patient once every two (2) years without a prescription;

     (v) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (vi) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (vii) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (3) A pharmacist shall dispense or administer a complete course of a post-exposure

prophylaxis drug as long as all of the following conditions are met:

     (i) The pharmacist screens the patient and determines that the exposure occurred within the

previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-

LC002548/SUB A - Page 9 of 11

exposure prophylaxis drug under CDC guidelines;

     (ii) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (iii) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (iv) The pharmacist notifies the patient's primary care provider of the dispensing or

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (4) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order or collaborative practice agreement.

     SECTION 5. This act shall take effect upon passage.

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LC002548/SUB A

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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

prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV

infection, commencing January 1, 2024. This act would also direct the board of pharmacy to

promulgate rules and regulations establishing standards for authorizing pharmacists to prescribe,

dispense and administer HIV prevention drugs in accordance with this section, including adequate

training requirements and protocols for when there is no prescription drug order, standing order or

collaborative practice agreement.

     This act would take effect upon passage.

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LC002548/SUB A

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