Title 27
Insurance

Chapter 20
Nonprofit Medical Service Corporations

§ 27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective until January 1, 2025.]

(a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall constitute a separate method of administration. A health insurer is not required to cover any pre-exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network pharmacy benefit.

(b) The healthcare benefits outlined in this section apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this section outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.

§ 27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective January 1, 2025.]

(a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall constitute a separate method of administration.

(b) The healthcare benefits outlined in this section apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this section outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.

(c) A health insurer shall provide access to at least one pre-exposure (“PrEP”) drug in each method of administration and at least one of the Centers for Disease Control and Prevention preferred post-exposure (“PEP”) drug treatment regimen, without any prior authorization or step therapy requirement. There shall be no copayment required, and no deductible shall need to be met, to obtain the prescription covered by the contract, plan, or policy.