2024 -- S 2255 SUBSTITUTE A

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LC004687/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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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:

     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 chapter 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 chapter 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 chapter 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 chapter 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

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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 chapter 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 chapter 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.

LC004687/SUB A - Page 3 of 5

     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 chapter 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 chapter 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).

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

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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

***

     This act would provide that a health insurer would 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 (CDC) and Prevention preferred post-exposure ("PEP") drug treatment regimen, without

any prior authorization or step therapy requirement. There would be no copayment required, and

no deductible would need to be met, to obtain the prescription covered by the insurance contract,

plan, or policy.

     This act would take effect on January 1, 2025.

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