§ 24-A §4317-D — Coverage of HIV prevention drugs

1.
Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
2.
Coverage required.
A carrier offering a health plan in this State shall provide coverage for an HIV prevention drug that has been prescribed by a provider or that has been prescribed, dispensed and administered by a pharmacist under Title 32, section 13786‑E. Coverage under this section is subject to the following.
3.
Limits on prior authorization and step therapy requirements.
Notwithstanding any requirements in section 4304 or 4320‑N to the contrary, a carrier may not subject any HIV prevention drug to any prior authorization or step therapy requirement except as provided in this subsection. If the federal Food and Drug Administration has approved one or more methods of administering HIV prevention drugs, a carrier is not required to cover all of the approved drugs without prior authorization or step therapy requirements as long as the carrier covers at least one approved drug for each method of administration without prior authorization or step therapy requirements. Notwithstanding this subsection, a carrier shall provide coverage without prior authorization or step therapy requirements for HIV prevention drugs for the prevention of the acquisition of HIV infection in accordance with a rating of A or B in the recommendations of the United States Preventive Services Task Force or equivalent rating from a successor organization and guidelines issued by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services. If prior authorization or step therapy requirements are met for a particular enrollee with regard to a particular HIV prevention drug, the carrier is required to cover that drug with no out-of-pocket cost to the enrollee.
4.
Coverage for laboratory testing related to HIV prevention drugs.
A carrier offering a health plan in this State shall provide coverage with no out-of-pocket cost for laboratory testing recommended by a provider related to the ongoing monitoring of an enrollee who is taking an HIV prevention drug covered by this section.

Legislative History

PL 2021, c. 265, §4 (NEW). PL 2021, c. 265, §8 (AFF). PL 2025, c. 483, §§2, 3 (AMD).