Amendment #816 to H4000

Removing Barriers to HIV Prevention Services

Mr. Lewis of Framingham moves to amend the bill by inserting the following section:

SECTION XXXX. Chapter 32A of the General Laws is hereby amended by inserting after section 17S the following section:-

Section 17T: (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) The commission shall provide any coverage for an HIV prevention drug to any active or retired employee of the commonwealth who is insured under the group health insurance commission:  (A) without requiring (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; and (B) shall not refuse, reject, or deny a prescription for any covered HIV prevention drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION XXXX. Chapter 118E of the General Laws is hereby amended by inserting after section 10Q the following section:-

Section 10R: (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) The division shall provide coverage for any HIV prevention drug: (A) without requiring (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; and (B) shall not refuse, reject, or deny a prescription for any covered HIV prevention drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION XXXX. Chapter 175 of the General Laws is hereby amended by inserting after section 47 UU the following section:-

Section 47VV: (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) Any individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance, which is issued or renewed within or without the commonwealth, and that provides coverage for any HIV prevention drug, shall not (A) require (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; or (B) refuse, reject, or deny a prescription for an HIV prevention  drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION XXXX. Chapter 176A of the General Laws is hereby amended by inserting after Section 8VV the following section:-

Section 8WW. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) A contract between a subscriber and the corporation under an individual or group hospital service plan which provides hospital expense and surgical expense insurance, except contracts providing supplemental coverage to Medicare or other governmental programs, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, which provides coverage for any HIV prevention drug shall not: (A) require (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii)  prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; or (B) refuse, reject, or deny a prescription for an HIV prevention  drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION XXXX. Chapter 176B of the General Laws is hereby amended by inserting after section 4VV the following section:-

Section 4WW.  (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) Any subscription certificate under an individual or group medical service agreement, except certificates that provide supplemental coverage to Medicare or other governmental programs, issued, delivered or renewed within or without the commonwealth that provides coverage for any HIV prevention drug shall not: (A) require (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; or (B) refuse, reject, or deny a prescription for an HIV prevention  drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION XXXX. Chapter 176G of the General Laws is hereby amended by inserting after section 4NN the following section:-

Section 4OO. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) A health maintenance contract issued or renewed within or without the commonwealth that provides coverage for any HIV prevention drug shall not: (A) require (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug, provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on co-payments, coinsurance or deductibles for these services; or (B) refuse, reject, or deny a prescription for an HIV prevention  drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION XXXX. Chapter 176I of the General Laws is hereby amended by adding the following section:-

Section 14. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) An organization entering into a preferred provider contract that provides coverage for any HIV prevention drug shall not: (A) require (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; or (B) refuse, reject, or deny a prescription for an HIV prevention  drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION XXXX. Chapter 176J of the General Laws is hereby amended by inserting after Section 17 the following section:-

Section 18. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) No carrier subject to this Chapter that provides coverage for any HIV prevention drug shall: (A) require (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; or (B) refuse, reject, or deny a prescription for an HIV prevention  drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

SECTION 9. Chapter 176Q of the General Laws is hereby amended by adding the following section:-

Section 17. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any preexposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration, including any ancillary or support health service determined by the secretary of health and human services that is necessary to: (1) ensure that such a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of such a drug; and (2) monitor such a person to ensure the safe and effective ongoing use of such a drug through: (A) an office visit; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; (E) or any other health service specified as part of comprehensive HIV prevention drug services by the United States Department of Health and Human Services, the United States Centers for Disease Control and Prevention or the United States Preventive Services Task Force, or an equivalent state-authorized body with responsibility to identify health services that are components of comprehensive HIV prevention drug services.

(b) No carrier subject to this Chapter that provides coverage for any HIV prevention drug shall: (A) require (i) any cost-sharing, including co-payments or co-insurance, or any deductible, and (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; or (B) refuse, reject, or deny a prescription for an HIV prevention  drug on the basis of the type or category of health care practitioner issuing the prescription or the venue or practice setting of the health care practitioner issuing the prescription, as long as the health care practitioner is licensed to prescribe medications.

Additional co-sponsor(s) added to Amendment #816 to H4000

Removing Barriers to HIV Prevention Services