Assembly Members Mark González and Haney's PrEPARE Act of 2025 revises health plan and insurer requirements for HIV prevention medications, eliminating prior authorization requirements and cost sharing for FDA-approved or CDC-recommended antiretroviral treatments.
The legislation prohibits health care service plans and insurers from requiring prior authorization, step therapy, or similar protocols that could delay access to HIV prevention medications. Plans must cover at least one therapeutically equivalent version without prior authorization, while providing access to other versions through exception requests. The bill specifically notes that long-acting medications with different durations are not considered therapeutically equivalent.
Under the new requirements, both grandfathered and non-grandfathered health plans must provide coverage for preexposure prophylaxis without imposing cost sharing. The legislation also mandates coverage for HIV prevention medications furnished by pharmacists, including related testing and services. Plans must cover these medications under outpatient prescription drug benefits and may supply providers directly with non-self-administered treatments.
The provisions exempt specialized dental and vision plans, Medicare supplement policies, and Medi-Cal managed care plans. For individual and small group health plans, the requirements take effect January 1, 2027. High-deductible health plans must comply with the cost-sharing provisions after a plan's deductible has been met, unless doing so would conflict with federal requirements.
![]() Shannon GroveR Senator | Committee Member | Not Contacted | |
![]() Scott WienerD Senator | Bill Author | Not Contacted | |
![]() Tim GraysonD Senator | Committee Member | Not Contacted | |
![]() Monique LimonD Senator | Committee Member | Not Contacted | |
![]() Maria DurazoD Senator | Committee Member | Not Contacted |
Bill Number | Title | Introduced Date | Status | Link to Bill |
---|---|---|---|---|
SB-427 | Health care coverage: antiretroviral drugs, drug devices, and drug products. | February 2023 | Failed |
Email the authors or create an email template to send to all relevant legislators.
Assembly Members Mark González and Haney's PrEPARE Act of 2025 revises health plan and insurer requirements for HIV prevention medications, eliminating prior authorization requirements and cost sharing for FDA-approved or CDC-recommended antiretroviral treatments.
The legislation prohibits health care service plans and insurers from requiring prior authorization, step therapy, or similar protocols that could delay access to HIV prevention medications. Plans must cover at least one therapeutically equivalent version without prior authorization, while providing access to other versions through exception requests. The bill specifically notes that long-acting medications with different durations are not considered therapeutically equivalent.
Under the new requirements, both grandfathered and non-grandfathered health plans must provide coverage for preexposure prophylaxis without imposing cost sharing. The legislation also mandates coverage for HIV prevention medications furnished by pharmacists, including related testing and services. Plans must cover these medications under outpatient prescription drug benefits and may supply providers directly with non-self-administered treatments.
The provisions exempt specialized dental and vision plans, Medicare supplement policies, and Medi-Cal managed care plans. For individual and small group health plans, the requirements take effect January 1, 2027. High-deductible health plans must comply with the cost-sharing provisions after a plan's deductible has been met, unless doing so would conflict with federal requirements.
Ayes | Noes | NVR | Total | Result |
---|---|---|---|---|
68 | 1 | 10 | 79 | PASS |
![]() Shannon GroveR Senator | Committee Member | Not Contacted | |
![]() Scott WienerD Senator | Bill Author | Not Contacted | |
![]() Tim GraysonD Senator | Committee Member | Not Contacted | |
![]() Monique LimonD Senator | Committee Member | Not Contacted | |
![]() Maria DurazoD Senator | Committee Member | Not Contacted |
Bill Number | Title | Introduced Date | Status | Link to Bill |
---|---|---|---|---|
SB-427 | Health care coverage: antiretroviral drugs, drug devices, and drug products. | February 2023 | Failed |