Pennsylvania SB 936: An Act requiring health insurance policies to provide coverage for postexposure prophylaxis HIV medication.

Bill Text

PRINTER'S NO. 1060
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 936
Session of
2025
INTRODUCED BY MUTH, HUGHES, KEARNEY, HAYWOOD, CAPPELLETTI,
SAVAL, COLLETT, FONTANA, TARTAGLIONE, COMITTA AND
SANTARSIERO, JULY 22, 2025
REFERRED TO BANKING AND INSURANCE, JULY 22, 2025
AN ACT
Requiring health insurance policies to provide coverage for
postexposure prophylaxis HIV medication.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the PEP for
Pennsylvania Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Health insurance policy."
(1) An individual or group health insurance policy,
contract or plan that provides medical or health care
coverage by a health care facility or licensed health care
provider on an expense-incurred service or prepaid basis that
is offered by or is governed under any of the following:
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(i) The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) The act of May 18, 1976 (P.L.123, No.54),
known as the Individual Accident and Sickness Insurance
Minimum Standards Act.
(iv) A nonprofit corporation subject to 40 Pa.C.S.
Ch. 61 (relating to hospital plan corporations) or 63
(relating to professional health services plan
corporations).
(2) The term does not include accident only, fixed
indemnity, limited benefit, credit, dental, vision, specified
disease, Medicare supplement, Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) supplement, long-
term care or disability income, workers' compensation or
automobile medical payment insurance.
"Postexposure prophylaxis HIV medication." A medication that
is approved by the United States Food and Drug Administration
that can be taken as a prophylaxis to prevent the transmission
of the human immunodeficiency virus.
Section 3. Mandated coverage.
(a) Coverage.--A health insurance policy that is delivered,
issued for delivery, renewed, extended or modified in this
Commonwealth on or after the effective date of this subsection
shall provide coverage for the expenses of any postexposure
prophylaxis HIV medication.
(b) Specialty tier.--Insurance providers may not move any
postexposure prophylaxis HIV medication into a specialty tier
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solely for monetary gains.
(c) Counseling.--No health care plan may impose counseling
from an infectious disease specialist or immunologist in order
to receive postexposure prophylaxis HIV medication unless
medically necessary.
Section 4. Effective date.
This act shall take effect in 60 days.
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