§ 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, 2024.]
(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 chapter 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 chapter 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.
History of Section.
P.L. 2023, ch. 254, § 3, effective January 1, 2024.