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HR 7385

PrEP Assistance Program Act

119th Congress Introduced by Yassamin Ansari and 15 co-sponsors

Establishes grants and a reimbursement program to expand PrEP access, cover related services for uninsured individuals, and reduce disparities in PrEP uptake.

Introduced in House
0
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Bill Summary · HR 7385

Summary of Bill: PrEP Assistance Program Act (H.R. 7385, 119th Congress)

Purpose and Intent

  • Establish a grant-based program to support pre-exposure prophylaxis (PrEP) activities and services aimed at preventing HIV infection.
  • Provide a separate program to reimburse health care providers for certain HIV prevention items and services for uninsured individuals, tied to a "PrEP Pass" access mechanism.
  • Overall goal: expand access to PrEP, improve delivery of PrEP-related services, and reduce disparities in PrEP uptake among high-risk populations.

Key Provisions

1) PrEP Grant Program (Section 2)

  • By no later than one year after enactment, the Secretary of Health and Human Services (HHS), through the CDC Director and in collaboration with the HRSA Administrator, must establish a grant program to fund eligible entities to create or support PrEP programs.
  • Eligible entities may apply for grants by submitting applications detailing how funds will be used.
  • Preference in awarding grants is given to entities with:
    • A track record serving HIV-incidence hot spots, including rural, uninsured, or high-risk demographic groups.
    • Innovative service delivery models (e.g., vending machines, pop-up clinics, peer-led interventions).
  • Grant awards may not exceed $10,000,000 per recipient.
  • Approved funds must be used for establishing or supporting PrEP programs.
  • Eligible uses of funds include a broad list of services and items (see below).
  • A list of eligible expenses includes: clinic and lab fees, office/telehealth visits, PrEP medications, blood/urine tests relevant to PrEP, STI testing per CDC guidelines, adherence counseling, outreach to health professionals and physicians, peer navigation, case management, transportation, mental health services, and other similar items.
  • Patients receiving PrEP services funded under the grant may not be charged; no required patient payments.
  • Matching requirement: Grantees (except Indian Tribal governments) must contribute at least 10% of grant amounts toward the program. A waiver can be granted for certain providers (e.g., federally qualified health centers, rural health clinics, community-based organizations, hospital- or university-based clinics) if the Secretary deems it necessary.

2) Reimbursement Program for Uninsured Individuals (Section 3)

  • Within one year of enactment, HHS must establish a program that allows program-registered providers to bill the Secretary for specified HIV prevention items and services provided to uninsured individuals.
  • The Secretary will pay eligible providers an amount for each prescribed item or service, based on a payment schedule that will be set and periodically reviewed (at least every two years).
  • The program includes a "PrEP Pass" card or similar technology to enable uninsured individuals to access eligible HIV prevention items and services at no cost from program-registered providers.
  • Definitions clarify:
    • "Specified HIV prevention items and services" include FDA-approved PrEP drugs and related administrative fees, plus lab tests and diagnostic procedures recommended by CDC clinical practice guidelines.
    • A “program-registered provider” is a licensed provider who agrees not to bill uninsured individuals for services covered by the program.
    • An “uninsured individual” is someone not enrolled in Medicare/Medicaid, a group health plan, or market-based private health coverage.
    • The Secretary is the HHS Secretary acting through the HRSA Administrator.

Affected Parties

  • Eligible entities (States, local governments, Indian Tribal governments, Federally qualified health centers, rural health clinics, community-based organizations, hospital-based clinics, and university-based clinics) may apply for PrEP grants.
  • Program-registered health care providers who furnish specified HIV prevention items/services to uninsured individuals may participate in the reimbursement program.
  • Uninsured individuals seeking PrEP and related services would benefit from reduced or zero out-of-pocket costs through the grant-supported programs and the PrEP Pass.

Funding and Timelines

  • Authorization of appropriations: $400,000,000 per fiscal year for 2027 through 2031 to carry out the Act.
  • Implementation timelines:
    • Grants and reimbursement program must be established within one year of enactment.
    • Each of the first five years after enactment requires a public report from HHS evaluating grant impact, disaggregated by race, gender identity, age, and geography, and assessing reductions in disparities and PrEP prevalence.
  • Reporting: Annual (for five years) public reports on impact and progress.

Practical Implications

  • Increased funding and grants could expand PrEP access in underserved communities and rural areas, with emphasis on innovative delivery methods.
  • The reimbursement program for uninsured individuals aims to remove financial barriers to PrEP and related services for those without insurance.
  • The impact will depend on grant allocation, provider participation, and the extent to which waivers are applied to reduce administrative or financial barriers.
  • Data reporting requirements will help monitor disparities and outcomes across demographics and regions.

Notes on Definitions

  • Terms clarified include eligible entity, PrEP program, PrEP medication, program-registered provider, and uninsured individual, ensuring clarity on who can receive benefits and who can apply or participate.

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

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