The bill amends Section 27-18-91 of the General Laws to ensure that, starting January 1, 2024, all group health insurance contracts and policies in the state must cover pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention. It mandates that insurers provide coverage for at least one PrEP drug in each method of administration and one CDC-preferred PEP treatment regimen without requiring prior authorization, step therapy, copayments, or deductibles. The bill also removes the stipulation that PrEP or PEP must be dispensed or administered by an in-network pharmacy provider.

Additionally, the bill repeals Sections 27-18-92, 27-19-84, and 27-20-80 of the General Laws, which are related to insurance coverage requirements for PrEP and PEP, and makes corresponding changes to Sections 27-19-83 and 27-20-79. These changes also eliminate the need for prior authorization and financial barriers such as copayments and deductibles for at least one drug in each method of administration for PrEP and PEP. The bill further deletes language regarding expedited prior authorization and repeals Section 27-41-97, which dealt with expedited prior authorization in the context of Health Maintenance Organizations. The act is scheduled to take effect on January 1, 2025, with the intention of improving access to HIV prevention medications.

Statutes affected:
7625  SUB A: 27-18-91, 27-18-92, 27-19-83, 27-19-84, 27-20-79, 27-20-80, 27-41-96, 27-41-97
7625: 27-18-91, 27-18-92, 27-19-83, 27-19-84, 27-20-79, 27-20-80, 27-41-96, 27-41-97