2024 -- S 2255

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LC004687

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES --

INSURANCE COVERAGE FOR PREVENTION OF HIV INFECTION

     

     Introduced By: Senators Murray, Pearson, Miller, Sosnowski, Bissaillon, Valverde,
Lauria, Quezada, Tikoian, and Ujifusa

     Date Introduced: February 06, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 27-18-91 of the General Laws in Chapter 27-18 entitled "Accident

2

and Sickness Insurance Policies" is hereby amended to read as follows:

3

     27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the

4

prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective

5

January 1, 2024.]

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 pre-

12

exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-

13

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

 

1

the health insurer’s network.

2

     (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any

3

HIV prevention drug to any prior authorization or step therapy requirement. There shall be no

4

copayment required, and no deductible shall need to be met, to obtain the prescription covered by

5

the contract, plan, or policy.

6

     SECTION 2. Section 27-18-92 of the General Laws in Chapter 27-18 entitled "Accident

7

and Sickness Insurance Policies" is hereby repealed.

8

     27-18-92. Expedited prior authorization. [Effective January 1, 2024.]

9

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

10

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-

11

18.9-6(a)(1).

12

     SECTION 3. Section 27-19-83 of the General Laws in Chapter 27-19 entitled "Nonprofit

13

Hospital Service Corporations" is hereby amended to read as follows:

14

     27-19-83. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the

15

prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective

16

January 1, 2024.]

17

     (a) Every group health insurance contract, or every group hospital or medical expense

18

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

19

any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of

20

pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis

21

(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall

22

constitute a separate method of administration. A health insurer is not required to cover any pre-

23

exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-

24

of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network

25

pharmacy benefit.

26

     (b) The healthcare benefits outlined in this chapter apply only to services delivered within

27

the health insurer’s provider network; provided that, all health insurers shall be required to provide

28

coverage for those benefits mandated by this chapter outside of the health insurer’s provider

29

network where it can be established that the required services are not available from a provider in

30

the health insurer’s network.

31

     (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any

32

HIV prevention drug to any prior authorization or step therapy requirement. There shall be no

33

copayment required, and no deductible shall need to be met, to obtain the prescription covered by

34

the contract, plan, or policy.

 

LC004687 - Page 2 of 5

1

     SECTION 4. Section 27-19-84 of the General Laws in Chapter 27-19 entitled "Nonprofit

2

Hospital Service Corporations" is hereby repealed.

3

     27-19-84. Expedited prior authorization. [Effective January 1, 2024.]

4

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

5

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-

6

18.9-6(a)(1).

7

     SECTION 5. Section 27-20-79 of the General Laws in Chapter 27-20 entitled "Nonprofit

8

Medical Service Corporations" is hereby amended to read as follows:

9

     27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the

10

prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective

11

January 1, 2024.]

12

     (a) Every group health insurance contract, or every group hospital or medical expense

13

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

14

any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of

15

pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis

16

(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall

17

constitute a separate method of administration. A health insurer is not required to cover any pre-

18

exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-

19

of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network

20

pharmacy benefit.

21

     (b) The healthcare benefits outlined in this chapter apply only to services delivered within

22

the health insurer’s provider network; provided that, all health insurers shall be required to provide

23

coverage for those benefits mandated by this chapter outside of the health insurer’s provider

24

network where it can be established that the required services are not available from a provider in

25

the health insurer’s network.

26

     (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any

27

HIV prevention drug to any prior authorization or step therapy requirement. There shall be no

28

copayment required, and no deductible shall need to be met, to obtain the prescription covered by

29

the contract, plan, or policy.

30

     SECTION 6. Section 27-20-80 of the General Laws in Chapter 27-20 entitled "Nonprofit

31

Medical Service Corporations" is hereby repealed.

32

     27-20-80. Expedited prior authorization. [Effective January 1, 2024.]

33

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

34

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant § 27-

 

LC004687 - Page 3 of 5

1

18.9-6(a)(1).

2

     SECTION 7. Section 27-41-96 of the General Laws in Chapter 27-41 entitled "Health

3

Maintenance Organizations" is hereby amended to read as follows:

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. [Effective

6

January 1, 2024.]

7

     (a) Every group health insurance contract, or every group hospital or medical expense

8

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

9

any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of

10

pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis

11

(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall

12

constitute a separate method of administration. A health insurer is not required to cover any pre-

13

exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-

14

of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network

15

pharmacy benefit.

16

     (b) The healthcare benefits outlined in this chapter apply only to services delivered within

17

the health insurer’s provider network; provided that, all health insurers shall be required to provide

18

coverage for those benefits mandated by this chapter outside of the health insurer’s provider

19

network where it can be established that the required services are not available from a provider in

20

the health insurer’s network.

21

     (c) Notwithstanding any requirements to the contrary, a health insurer shall not subject any

22

HIV prevention drug to any prior authorization or step therapy requirement. There shall be no

23

copayment required, and no deductible shall need to be met, to obtain the prescription covered by

24

the contract, plan, or policy.

25

     SECTION 8. Section 27-41-97 of the General Laws in Chapter 27-41 entitled "Health

26

Maintenance Organizations" is hereby repealed.

27

     27-41-97. Expedited prior authorization. [Effective January 1, 2024.]

28

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

29

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-

30

18.9-6(a)(1).

31

     SECTION 9. This act shall take effect on January 1, 2025.

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LC004687

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LC004687 - Page 4 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES --

INSURANCE COVERAGE FOR PREVENTION OF HIV INFECTION

***

1

     This act would eliminate prior authorization or step therapy requirement for prescriptions

2

for any HIV prevention drug. This act would also prohibit the requirement of any copayment or the

3

meeting of any deductible to obtain the prescription covered by the contract, plan, or policy.

4

     This act would take effect on January 1, 2025.

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LC004687

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LC004687 - Page 5 of 5