Section 81 PREP Coverage 4

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.
"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) 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, however, that the health care provider shall be licensed to prescribe medications.