Post-exposure prophylaxis, or PEP, is the commonly used term for a drug regime taken within 72 hours after a possible exposure to  human immunodeficiency virus (HIV) to prevent HIV infection. The Centers for Disease Control and Prevention (CDC) has developed guidelines for the administration of PEP, which includes prescribing a 28-day course of treatment after a patient reports exposure to bodily fluids, the source of which is known to be HIV positive, within the last 72 hours and that exposure presents a substantial risk for transmission. A case-by-case determination is recommended when the HIV infection status of the source of the body fluids is unknown and the circumstances of the reported exposure presents a substantial risk for transmission.

Hospitals must adopt a policy, consistent with CDC guidelines, for the dispensing of PEP. This policy must ensure that hospital staff dispense to a patient, with a patient's informed consent, a 5-day supply of PEP drugs or therapies following the patient's possible exposure to HIV, unless medically contraindicated, inconsistent with care and treatment standards, or inconsistent with CDC guidelines. . This requirement does not affect reimbursement for PEP drugs though the Crime Victims Compensation Program or the Industrial Insurance Act.

Beginning in 2025 non-grandfathered health plans, including those offered to public employees , and Medicaid may not impose cost sharing or require prior authorization for the drugs that comprise at least one regimen recommended by the CDC for HIV PEP drugs. . For health plans with a health savings account (HSA) the carrier must set the cost-sharing amount at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions and withdrawals from the HSA. 

Notwithstanding the coverage requirements, health plans, including those offered the public employees, and Medicaid, must reimburse hospitals, as a separate expense, for a 5-day supply of any PEP drugs or therapies dispensed or delivered to a patient in the emergency department for take-home use.

The committee recommended a different version of the bill than what was heard. PRO: There are proven treatments to prevent infection of HIV, but you must get access to the drugs within 72 hours so it is important for them to be widely available. This is especially important for sexual assault survivors and frontline medical workers. There is a lack of meaningful access because of cost or lack of supply in certain areas. Obtaining, filling, and paying for drugs are often problems. 

OTHER: The use of prior authorization is vital for cost control, and drugs can be approved through prior authorization in one day for an expedited request. There are outstanding questions about reimbursement for hospitals. The bill lacks clarity for related to distribution to critical access hospitals. These drugs are very fragile and must be dispensed in original their container, so repackaging is not practical or safe. The crime victims fund could be used to help cover costs.