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H 4951

An Act to address barriers to HIV prevention medication

194th Legislature (2025-2026) Introduced by Jack Lewis and 2 co-sponsors

The bill removes cost-sharing and restrictive rules for HIV prevention drugs (PrEP), expands pharmacist prescribing, and ensures pre-release and broad coverage access across public

Reporting date extended to Thursday, December 31, 2026
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Bill Summary · H 4951

Overview

  • Bill: H 4951 (194th Session, Massachusetts)
  • Title: An Act to address barriers to HIV prevention medication
  • Purpose: Remove financial and administrative barriers to HIV prevention drugs (preexposure prophylaxis, PrEP) and expand access across multiple public and private health coverage programs. The bill aims to ensure no cost-sharing or restrictive utilization requirements, and to broaden prescribing authority to include pharmacists, among other access-enhancing provisions.

Key Provisions

The bill makes uniform changes across several chapters of the General Laws to ensure broad, barrier-free coverage and access to HIV prevention drugs. Major elements include:

  • Definitions

    • Defines “HIV prevention drug” as any FDA-approved PrEP medication, including related health services necessary for safe prescribing, monitoring, adherence counseling, lab testing, STI testing, and other required services.

  • State employee and public program coverage (Sections 3–6)

    • For Commonwealth group health plans (Chapter 32A, 118E, 175, 176A, 176B, 176G, 176I, 176J, 176Q):
    • Prohibits cost-sharing for HIV prevention drugs (no co-pays, co-insurance, or deductibles).
    • Prohibits prior authorization, step therapy, or other protocols that could delay dispensing.
    • Prohibits denial of a prescription based on the prescribing practitioner’s type, category, or the setting where prescribed, as long as the practitioner is licensed to prescribe medications.
    • Applies to both public and private sector coverages within the specified chapters (public employee programs and certain insurance contract types).

  • School of correctional facilities and public-private insurance coordination (Section 9)

    • Expands coverage protections to include substances under certain subscription certificates and health plans, ensuring no cost-sharing or restrictive utilization practices for HIV prevention drugs within those plans.

  • Employer and carrier contracts (Section 8, 7, 10)

    • Applies to health maintenance contracts, preferred provider contracts, and subscription certificates, ensuring barrier-free access (no cost-sharing or prior authorization) for HIV prevention drugs, subject to tax-structure considerations where applicable.

  • Incarcerated populations (Section 11)

    • In state and county correctional facilities, mandates pre-release considerations for HIV prevention drugs:
    • Inmates negative for HIV, meeting certain criteria, must receive information and counseling about PrEP.
    • Eligible inmates may receive a supply of HIV prevention drugs prior to release (up to 90-day oral supply or other appropriate form) with a plan for post-release continuity of care.
    • No cost to the inmate for pre-release supplies.
    • Confidential handling of evaluation information.

  • Pharmacist authority (Section 2)

    • Grants licensed pharmacists in Massachusetts the authority to prescribe, dispense, or administer HIV prevention drugs.
    • The Department of Public Health, with input from the Board of Registration in Pharmacy, will promulgate implementing regulations outlining the terms and conditions of pharmacist authority.

Affected Parties

  • Individuals at risk for HIV who may use PrEP (HIV prevention drugs) under various insurance or public programs.
  • State employees and retirees covered by the Group Health Insurance program.
  • Recipients of Medicaid and other health coverage administered through MA programs, as the bill expands private and public payer protections.
  • Health care providers, including physicians, nurse practitioners, physician assistants, and licensed pharmacists.
  • Correctional facility inmates nearing release who may receive PrEP-related counseling and medication prior to release.
  • Insurance carriers and health plan administrators (HMOs, hospital service plans, and other policies) to align plan design with the new prohibitions on barriers.

Procedural and Timeline Aspects

  • Legislative path:
    • Committee: Financial Services reviewed and recommended passage (January 28, 2026).
    • The bill has a companion or related drafting path’s movement to Health Care Financing for further consideration.
  • Effective dates:
    • The text does not specify exact effective dates for all provisions; typical implementation would require regulatory rulemaking and a defined effective date upon passage. For pharmacist authority and some coverage provisions, implementing regulations would be issued by the Department of Public Health and relevant boards.

Impact and Implications

  • Access and Equity: By eliminating cost-sharing and prior authorization for HIV prevention drugs across multiple payer types, the bill seeks to reduce financial and administrative barriers to PrEP.
  • Provider Flexibility: Expands prescribing authority to licensed pharmacists, potentially increasing access points for PrEP.
  • Continuity of Care: Provisions for pre-release PrEP access aim to reduce HIV acquisition risk among exiting inmates by ensuring continuity of care.
  • Public Health Alignment: Aligns state law with federal guidance on comprehensive HIV prevention services and removes barriers to evidence-based prevention.

Note: The summary reflects the bill’s substantive provisions as written. For final wording, amendments, or enacted language, refer to the enacted statute and its regulatory implementations.

Compiled from official sources — confirm details with the bill’s official record.

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