Amendment 800

Budget Amendment ID: FY2027-S4-800

OTH 800

HIV Prevention

Mr. Cyr moved that the proposed new text be amended by adding the following sections:-

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

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

“Cost sharing”, a deductible, coinsurance, copayments and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

“Health care provider”, as defined in section 1 of chapter 111.

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any pre-exposure 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 to be necessary to: (i) ensure that a drug is prescribed or administered to a person who is not infected with HIV and has no medical contraindications to the use of a drug; and (ii) monitor a person to ensure the safe and effective ongoing use of a drug through: (A) office visits; (B) laboratory testing; (C) testing for a sexually transmitted infection; (D) medication self-management and adherence counseling; or (E) any other health service specified as part of comprehensive HIV prevention drug services by the U.S. Department of Health and Human Services, the federal Centers for Disease Control and Prevention, 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 active or retired employee of the commonwealth, insured under the commission, coverage for an HIV prevention drug. There shall be no: (i) patient cost sharing; or (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug.

(c) The commission shall not refuse, reject or deny a prescription for any covered HIV prevention drug on the basis of the type of health care provider issuing the prescription for an HIV prevention drug or the venue or practice setting of the health care provider issuing the prescription; provided, that the health care provider shall be licensed to prescribe medications.

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

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

“Health care provider”, as defined in section 1 of chapter 111.

“HIV”, human immunodeficiency virus.

(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for an HIV prevention drug. There shall be no: (i) patient cost sharing; or (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug.

(c) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall not refuse, reject or deny a prescription for any covered HIV prevention drug on the basis of the type of health care provider issuing the prescription for an HIV prevention drug or the venue or practice setting of the health care provider issuing the prescription; provided, that the health care provider shall be licensed to prescribe medications.

SECTION X. Chapter 127 of the General Laws is hereby amended by inserting after section 17D the following section:-

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

“County correctional facility”, as defined in paragraph (f) of section 1 of chapter 125.

“Health care provider”, as defined in section 1 of chapter 111.

“HIV”, human immunodeficiency virus.

“HIV prevention drug”, any pre-exposure prophylaxis drug approved for the prevention of HIV by the federal Food and Drug Administration.

(b) The superintendent of each state correctional facility and the administrator of each county correctional facility shall ensure that within a reasonable time prior to release each inmate of a state correctional facility and county correctional facility who has been committed to a term of 30 days or more, and who is negative for HIV infection, shall be:

(i) provided information and counseling about HIV prevention drugs to prevent HIV acquisition;

(ii) evaluated for the benefit of an HIV prevention drug, with the consent of the inmate;

(iii) provided with a supply of an HIV prevention drug prior to release, to an eligible inmate with their consent; provided, that the supply of an HIV prevention drug shall, at the inmate’s option, include administration immediately prior to release of the longest duration injectable form of an HIV prevention drug, a 90-day supply of an oral HIV prevention drug, any other clinically appropriate HIV prevention drug or a prescription for such supply to be filled post-release; and

(iv) provided with information about requirements for medical monitoring after release to ensure the safe and effective ongoing use of HIV prevention drugs; provided, that each state correctional facility and county correctional facility shall develop and implement a plan to connect each inmate receiving an HIV prevention drug to post-release medical and other services to ensure ongoing HIV prevention therapy upon release.

(d) Each state correctional facility and county correctional facility evaluating an inmate for an HIV prevention drug pursuant to subsection (b) shall ensure that information obtained for such evaluation shall be kept confidential between the inmate and medical provider and shall not be shared with security or administrative staff.

(e) The department of correction, in consultation with the department of public health, shall promulgate regulations or issue guidance for the implementation of this section.

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

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

“Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

“Health care provider”, as defined in section 1 of chapter 111.

“HIV”, human immunodeficiency virus.

(b) Any policy of accident and sickness insurance, as described in section 108, that provides hospital expense and surgical expense insurance that is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth and any group blanket or general policy of accident and sickness insurance, issued under section 110, that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, that provides coverage for any HIV prevention drug shall not require: (i) patient cost sharing; or (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug.

(c) Any policy of accident and sickness insurance, as described in section 108, that provides hospital expense and surgical expense insurance that is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth and any group blanket or general policy of accident and sickness insurance, issued under section 110, that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, that provides coverage for any HIV prevention drug shall not refuse, reject or deny a prescription for any covered HIV prevention drug on the basis of the type of health care provider issuing the prescription for an HIV prevention drug or the venue or practice setting of the health care provider issuing the prescription; provided, that the health care provider shall be licensed to prescribe medications.

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

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

“Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

“Health care provider”, as defined in section 1 of chapter 111.

“HIV”, human immunodeficiency virus.

(b) Any contract between a subscriber and the corporation under an individual or group hospital service plan that provides hospital expense and surgical expense insurance, except contracts providing supplemental coverage to Medicare or other governmental programs, that is delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, that provides coverage for any HIV prevention drug shall not require: (i) patient cost sharing; or (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug.

(c) Any contract between a subscriber and the corporation under an individual or group hospital service plan that provides hospital expense and surgical expense insurance, except contracts providing supplemental coverage to Medicare or other governmental programs, that is delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, that provides coverage for any HIV prevention drug shall not refuse, reject or deny a prescription for any covered HIV prevention drug on the basis of the type of health care provider issuing the prescription for an HIV prevention drug or the venue or practice setting of the health care provider issuing the prescription; provided, that the health care provider shall be licensed to prescribe medications.

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

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

“Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

“Health care provider”, as defined in section 1 of chapter 111.

“HIV”, human immunodeficiency virus.

(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 require: (i) patient cost sharing; or (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug.

(c) 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 refuse, reject or deny a prescription for any covered HIV prevention drug on the basis of the type of health care provider issuing the prescription for an HIV prevention drug or the venue or practice setting of the health care provider issuing the prescription; provided, that the health care provider shall be licensed to prescribe medications.

SECTION X. Chapter 176G 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, unless the context clearly requires otherwise, have the following meanings:

“Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

“Health care provider”, as defined in section 1 of chapter 111.

“HIV”, human immunodeficiency virus.

(b) An individual or group health maintenance contract that is issued, delivered or renewed, within or without the commonwealth, that provides coverage for any HIV prevention drug shall not require: (i) patient cost sharing; or (ii) prior authorization, step therapy or any other protocol that could restrict or delay the dispensing of any HIV prevention drug; provided, however, that cost sharing 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 cost sharing for these services.

(c) An individual or group health maintenance contract that is issued, delivered or renewed, within or without the commonwealth, that provides coverage for any HIV prevention drug shall not refuse, reject or deny a prescription for any covered HIV prevention drug on the basis of the type of health care provider issuing the prescription for an HIV prevention drug or the venue or practice setting of the health care provider issuing the prescription; provided, that the health care provider shall be licensed to prescribe medications.