PrEP Access Act
Summary
The PrEP Access Act aims to amend Title XVIII of the Social Security Act to include coverage for HIV prevention services provided by pharmacists under Medicare Part B. This includes services like pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and related clinical services. The bill ensures that Medicare will cover these services at 80% of the lesser of the actual charge or 85% of the physician fee schedule amount.
Expected Effects
The Act would expand access to HIV prevention services for Medicare beneficiaries by allowing pharmacists to provide these services. This could lead to increased rates of HIV prevention and early intervention. The bill also includes provisions to prevent balance billing for these services.
Potential Benefits
- Increased access to PrEP and PEP through pharmacists.
- Early detection and prevention of HIV.
- Reduced healthcare costs in the long term by preventing new HIV infections.
- Greater convenience for Medicare beneficiaries, especially in rural areas.
- Improved public health outcomes related to HIV prevention.
Most Benefited Areas:
Potential Disadvantages
- Potential increase in Medicare spending.
- Possible administrative challenges in implementing the new coverage.
- Concerns about the quality of care provided by pharmacists compared to physicians.
- Risk of inappropriate use of PrEP or PEP if not properly managed.
- The 80% coverage may still leave some beneficiaries with out-of-pocket costs.
Constitutional Alignment
The bill aligns with the Constitution's broad mandate to "promote the general Welfare" (Preamble). Congress has the power to tax and spend for the general welfare, and this bill falls under that power. The bill does not appear to infringe on any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).