B 26-0159 — PrEP DC Act of 2025

ENGROSSEDENROLLED ORIGINAL AAN BILLACT 3_________________________ 26-159 5 IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 7 _________________________ 9 To amend the Prohibition of Discrimination in the Provision of Insurance Act of 1986 to prohibit health benefit plans and health insurers from imposingfactoring costthe sharing,use priorof authorization,HIV orprevention medicallytreatment unnecessaryin restrictionsdecisions onrelated atto leastthe oneissuance regimen of HIVdisability, preventionlife, medicationor treatmentlong-term andcare services,insurance frompolicies, usingimposing prescriptioncost informationsharing, forprior HIVauthorization, preventionor treatmentmedically andunnecessary servicesrestrictions foron medicalHIV underwritingprevention forservices, individualPEP, patients,or andany toformulation prohibitof insurancePrEP, companiesand fromusing factoringprescription theinformation usefor of HIV prevention treatment infor decisionsmedical relatedunderwriting tofor theindividual issuancepatients; of disability, life, or long-term care insurance policies;

BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the “PrEP DC Amendment Act of 2025”.2026”.

ENGROSSED ORIGINAL Centers for Disease Control and Prevention, to be completed before prescribing HIV prevention medication, including screening tests for chlamydia, gonorrhea, syphilis, kidney function assessments, hepatitis B virus serology, and lipid profiles.

“(3B) “Health benefit plan” shall have the same meaning as provided in section 101(20) of the Health Insurance Portability and Accountability Federal Law Conformity and No- ENROLLED ORIGINAL Fault Motor Vehicle Insurance Act of 1998, effective April 13, 1999 (D.C.

Food and Drug Administration (“FDA”) used to prevent HIV in a person without ENGROSSED ORIGINAL HIV.

ENGROSSED ORIGINAL (2) Subsection (c) is amended to read as follows:

“(c) No health or disability insurance policy or contract shall contain any exclusion, reduction, other limitation of coverage, deductibles, or coinsurance provisions related to HIV prevention treatment or the care and treatment of AIDS, ARC, HIV infection, or any illness or ENROLLED ORIGINAL disease arising from these medical conditions, unless the provisions apply generally to all benefits under the policy or contract.”.

If the Commissioner determines that the result of the test of the proposed ENGROSSED ORIGINAL insured is not a true positive, the Commissioner shall order the insurer from which the applicant sought coverage to disregard the positive test result.

“(a)(1) Except as otherwise provided in subsection (b) of this section, for health benefit plans issued or renewed on or after January 1, 2027, an insurer may not impose cost sharing, require prior authorization, or impose any medically unnecessary restrictions ENGROSSED ORIGINAL or delays for the coverage of HIV prevention services, PEP, or any formulation of PrEPPrEP. approved by the FDA.

“(a)“(b) ExceptSubsection as(a) otherwise provided in subsection (b) of this section,section forshall healthnot benefitapply plansto issuedthe orextent renewedthat oncoverage orwithout aftercost-sharing Januarywould 1,disqualify 2027, an insurerindividual mayreceiving notcoverage imposeunder costa sharing,high requiredeductible priorhealth authorization,plan orfrom imposeeligibility any medically unnecessary restrictions or delays for thea coveragehealth ofENROLLED HIVORIGINAL preventionsavings servicesaccount andpursuant atto least26 oneU.S.C. regimen for PrEP and PEP.

“(b) Subsection (a) of this section shall not apply to the extent that coverage without cost- sharing would disqualify an individual receiving coverage under a high deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C.

“(d) For the purposes of this section, the term “medically unnecessary restrictions” means prior authorization, step therapy, waiting periods, or preexisting condition exclusions.”.

The Department of Health Functions Clarification Act of 2001, effective October 3, 2001 (D.C.

DistrictD.C. of Columbia Official Code § 7-731 et seq.), is amended by adding a new section 4907g to read as follows:

Official Code § 7-731 et seq.), is amended by adding a new section 4907g to read as follows:

“(a) There is established as a special fund the DC Health and Wellness Center Fund (“Fund”), which shall be administered by the Department of Health in accordance with ENGROSSED ORIGINAL subsection (c) of this section.

and.and “(3) Other collections.

“(3) Other collections.

This act shall take effect after approval by the Mayor (or in the event of veto by the ENROLLED ORIGINAL Mayor, action by the Council to override the veto) and a 30-day period of congressional review ENGROSSED ORIGINAL as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 24, 1973 (87 Stat.

___________________________________ Chairman Council of the District of Columbia _________________________________ Mayor District of Columbia 5