Text of DC B 260159 (2026)

February 28, 2025 Nyasha Smith, Secretary Council of the District of Columbia 1350 Pennsylvania Avenue, NW Washington, D.C. 20004 Dear Secretary Smith, On the heels of the observance of National Black HIV Awareness Day on February 8, 2025, I am introducing the “PrEP DC Act of 2025”. Please see enclosed signed copy of the legislation, which is co-introduced by Councilmembers Brianne K. Nadeau, Charles Allen, Janeese Lewis George, Anita Bonds, Christina Henderson, Robert C. White, Jr., Brooke Pinto, and Wendell Felder. This legislation is designed to aid in the District’s work to reduce HIV infections by creating more equitable and affordable access to HIV prevention treatment in three ways, by: • prohibiting health benefit plans and health insurers from using prescription information as a condition of eligibility or in premium rates, • prohibiting insurers from restricting or imposing setting delays in the distribution of antiretroviral prescription drugs prescribed to a person for the treatment or prevention of the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), and • prohibiting health insurers from imposing a deductible, coinsurance, copayment, or other cost-sharing requirement for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) to prevent HIV and AIDS infection. By creating these safeguards, we will reduce stigma and discrimination against individuals accessing PrEP or any other form of HIV prevention treatment. This is significant for the LGBTQ community, but is also an important tool for keeping our DC residents healthy. According to the 2024 Annual Epidemiology & Surveillance Report from DC Health, approximately 11,670 current residents of the District, or 1.7% of the population, are living with HIV, with some of the highest concentrations of these residents in Wards 5, 7, and 8.1 Young people aged 18-24 represented 22% of newly diagnosed HIV infections in 2023, a 4% increase from 2022.2 HIV prevention treatments like PrEP have been shown to decrease the spread of HIV, and DC Health reported that in 2023, there were just 192 new HIV cases, which is the lowest annual total since the 1990s.3 This legislation will serve as another critical tool to help combat the spread of HIV. HIV prevention initiatives through DC Health’s HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) include the Pre Exposure Prophylaxis Drug Assistance Program (PREP DAP), which pays the monthly co-pay and deductibles for eligible insured and uninsured HIV negative residents in the DC metropolitan area who are at high risk of HIV infection and are prescribed Truvada as PrEP. For questions about this program, you can call (202) 671-4815. Please feel free to reach out to me or my Legislative Director, Neferteria Brown, with any questions or for additional information. She can be reached at nbrown@dccouncil.gov or by phone at (771) 333-9734. Sincerely, Zachary Parker Ward 5 Councilmember Chair, Committee on Youth Affairs 1 Annual Epidemiology & Surveillance Report: Data Through December 2023. District of Columbia Department of Health, HIV/AIDS, Hepatitis, STI, & TB Administration 2024. Accessed February 28, 2025, at https://dchealth.dc.gov/service/hiv-reports-and-publications 2 Id. 3 Id. 1 _____________________________ _______________________________ 2 Councilmember Brianne K. Nadeau Councilmember Zachary Parker 3 4 5 6 _____________________________ _______________________________ 7 Councilmember Charles Allen Councilmember Janeese Lewis George 8 9 10 11 _____________________________ ______________________________ 12 Councilmember Anita Bonds Councilmember Christina Henderson 13 14 15 16 _____________________________ _______________________________ 17 Councilmember Robert C. White, Jr. Councilmember Brooke Pinto 18 19 20 21 _____________________________ 22 Councilmember Wendell Felder 23 24 25 26 A BILL 27 28 _________________________ 29 30 IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 31 32 _________________________ 33 34 35 To prohibit health benefit plans and health insurers from using prescription information as a 36 condition of eligibility or in setting premium rates, to prohibit insurers from restricting or 37 imposing delays in the distribution of antiretroviral prescription drugs prescribed to a 38 person for the treatment or prevention of the human immunodeficiency virus (HIV) or 39 acquired immunodeficiency syndrome (AIDS), and to prohibit health insurers from 40 imposing a deductible, coinsurance, copayment, or other cost-sharing requirement for 41 PrEP or PEP to prevent HIV and AIDS infection. 42 43 BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may 44 be cited as the “PrEP DC Act of 2025”. 45 Sec. 2. For the purposes of this act, the term: 46 (1) “AIDS” means acquired immune deficiency syndrome. 47 (2) “Baseline Assessment” means any testing, as recommended by the U.S. 48 Centers for Disease Control and Prevention, to be completed before prescribing an HIV 49 prevention medication. This testing includes, but is not limited to, the following: screening tests 50 for chlamydia, gonorrhea, and syphilis; kidney function assessments; hepatitis B virus serology, 51 and lipid profiles. 52 (3) “Commissioner” means the Commissioner of the Department of Insurance and 53 Securities Regulation. 54 (4) “Group health plan” means an employee welfare plan (as defined in section 55 3(1) of the Employee Retirement Income Security Act of 1974, approved September 2, 1974 (88 56 Stat. 829; 29 U.S.C. § 1002(1)), to the extent that the plan provides medical care and includes 57 items and services paid for as medical care to employees or their dependents (as defined under 58 the terms of the plan) directly or through insurance, reimbursement, or otherwise. 59 (5) “Health benefit plan” means any accident and health insurance policy or 60 certificate, hospital and medical services corporation contract, health maintenance organization 61 subscriber contract, plan provided by a multiple employer welfare arrangement, or plan provided 62 by another benefit arrangement. The term “health benefit plan” does not mean accident only, 63 credit, or disability insurance; coverage of Medicare services or federal employee health plans, 64 pursuant to contracts with the United States government; Medicare supplemental or long-term 65 care insurance; dental only or vision only insurance; specified disease insurance; hospital 66 confinement indemnity coverage; limited benefit health coverage; coverage issued as a 67 supplement to liability insurance, insurance arising out of a workers’ compensation or similar 68 law; automobile medical payment insurance; medical expense and loss of income benefits; or 69 insurance under which benefits are payable with or without regard to fault and that is statutorily 70 required to be contained in any liability insurance policy or equivalent self-insurance. 71 (6) “Health insurer” means any person that provides one or more health benefit 72 plans or insurance in the District of Columbia, including an insurer, a hospital and medical 73 services corporation, a fraternal benefit society, a health maintenance organization, a multiple 74 employer welfare arrangement, or any other person providing a plan of health insurance subject 75 to the authority of the Commissioner. 76 (7) “HIV” means the human immunodeficiency virus. 77 (8) “HIV prevention treatment” means any medical treatment, including PrEP and 78 PEP, that is used to aid in HIV and AIDS prevention. 79 (9) “Individual health plan” means a plan offering health insurance coverage 80 offered to individuals other than in connection with a group health plan. 81 (10) “PrEP” means pre-exposure prophylaxis, an antiretroviral medication used to 82 prevent HIV in a person without HIV. 83 (11) “PEP” means post-exposure prophylaxis, an antiretroviral medication(s) used 84 to prevent HIV in a person without HIV who may have been recently exposed to HIV. 85 Sec. 4. Coverage for HIV Prevention Treatment. 86 (a) Each individual health plan, group health plan, or health benefit plan issued or 87 renewed in the District of Columbia shall provide coverage for HIV prevention treatment, 88 including PrEP and PEP, and any baseline assessments required, in accordance with the latest 89 HIV prevention guidelines promulgated by the U.S. Centers for Disease Control and Prevention. 90 (b) The coverage provided under this section shall not be more restrictive than or separate 91 from coverage provided from any other illness, condition, or disorder for purposes of 92 determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar 93 limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year 94 maximum for deductibles and copayments and coinsurance factors. 95 (c) No individual health plan, group health plan, or health benefit plan covered under this 96 section shall be allowed to use prescription information indicating HIV prevention treatment as a 97 condition of eligibility or in setting premium rates. 98 (d) No individual health plan, group health plan, or health benefit plan covered under this 99 section shall impose any medically unnecessary restrictions or delays on the coverage required 100 by this section. 101 (e) A health insurer shall not impose on an individual receiving benefits pursuant to this 102 section, to include HIV prevention treatment and any baseline assessments, any deductible, 103 coinsurance, copayment, or other cost-sharing requirement, except to the extent that coverage 104 without cost-sharing would disqualify the individual from a high deductible health benefit plan, 105 as defined in 26 U.S.C. § 223(c)(2)), from eligibility for a health savings account pursuant to 26 106 U.S.C. § 223. 107 (f) Coverage for services under this section shall be provided without discrimination on 108 the basis of age, ancestry, disability, domestic partner status, gender, gender expression, gender 109 identity, genetic information, marital status, national origin, race, religion, sex, or sexual 110 orientation. 111 Sec. 5. Applicability. 112 This chapter shall apply to all individual and group health benefits plans issued or 113 renewed on or after 120 days after January 1, 2026. 114 Sec. 6. Regulations. 115 The Commissioner may issue rules and regulations necessary to implement the 116 provisions of this Act. 117 Sec. 7. Fiscal impact statement. 118 The Council adopts the fiscal impact statement in the committee report as the fiscal 119 impact statement required by section 4a of the General Legislative Procedures Act of 1975, 120 approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 121 Sec. 8. Effective date. 122 This act shall take effect after approval by the Mayor (or in the event of veto by the 123 Mayor, action by the Council to override the veto), a 30-day period of congressional review as 124 provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 125 24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of 126 Columbia Register. 127

ENROLLED ORIGINAL 1 AN ACT _________________________ IN THE COUNCIL OF THE DISTRICT OF COLUMBIA _________________________ To amend the Prohibition of Discrimination in the Provision of Insurance Act of 1986 to prohibit health benefit plans and health insurers from factoring the use of HIV prevention treatment in decisions related to the issuance of disability, life, or long-term care insurance policies, imposing cost sharing, prior authorization, or medically unnecessary restrictions on HIV prevention services, PEP, or any formulation of PrEP, and using prescription information for HIV prevention treatment for medical underwriting for individual patients; and to amend the Department of Health Functions Clarification Act of 2001 to establish a non-lapsing DC Health and Wellness Center Fund to collect revenue from insurance and out-of-pocket costs paid for services provided by the DC Health and Wellness Center and affiliated clinics, and to require the funds be spent solely on the operations of the DC Health and Wellness Center and affiliated clinics. BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the “PrEP DC Amendment Act of 2026”. Sec. 2. The Prohibition of Discrimination in the Provision of Insurance Act of 1986, effective August 7, 1986 (D.C. Law 6-132; D.C. Official Code § 31-1601 et seq.), is amended as follows: (a) Section 2 (D.C. Official Code § 31-1601) is amended as follows: (1) New paragraphs (2A) and (2B) are added to read as follows: “(2A) “Baseline assessment” means any testing, as recommended by the U.S. Centers for Disease Control and Prevention, to be completed before prescribing HIV prevention medication, including screening tests for chlamydia, gonorrhea, syphilis, kidney function assessments, hepatitis B virus serology, and lipid profiles. “(2B) “Commissioner” means the Commissioner of the Department of Insurance, Securities, and Banking.”. (2) A new paragraph (3B) is added to read as follows: “(3B) “Health benefit plan” shall have the same meaning as provided in section 101(20) of the Health Insurance Portability and Accountability Federal Law Conformity and No- ENROLLED ORIGINAL 2 Fault Motor Vehicle Insurance Act of 1998, effective April 13, 1999 (D.C. Law 12-209; D.C. Code § 31-3301.01(20)).”. (3) New paragraphs (5A) and (5B) are added to read as follows: “(5A) “HIV prevention services” means medical services to prevent HIV and AIDS, including baseline assessments, initial and follow-up appointments and services, medication for the management of side effects associated with PrEP and PEP, and medication self-management or adherence counseling. “(5B) “HIV prevention treatment” means medical treatment used to prevent HIV, including PrEP, PEP, and HIV prevention services.”. (4) New paragraphs (7A) and (7B) are added to read as follows: “(7A) “PrEP” means pre-exposure prophylaxis antiretroviral medication approved by the U.S. Food and Drug Administration (“FDA”) used to prevent HIV in a person without HIV. “(7B) “PEP” means post-exposure prophylaxis antiretroviral medication approved by the FDA used to prevent HIV in a person without HIV who may have been recently exposed to HIV.”. (b) Section 4 (D.C. Official Code § 31-1603) is amended as follows: (1) Subsection (b) is amended to read as follows: “(b)(1) In determining whether to issue, cancel, or renew insurance coverage, an insurer may not: “(A) Use age, marital status, geographic area of residence, occupation, sex, sexual orientation, gender identity or expression, or any similar factor or combination of factors for the purpose of seeking to predict whether any individual may in the future develop AIDS or ARC; or “(B) Take into consideration an individual’s use of HIV prevention treatment when taken pursuant to a valid prescriber’s order. “(2) In determining rates, premiums, dues, assessments, benefits covered, or expenses reimbursable, or in any other aspect of insurance marketing or coverage, an insurer may not: “(A) Use age, marital status, geographic area of residence, occupation, sex, sexual orientation, gender identity or expression, or any similar factor or combination of factors for the purpose of seeking to predict whether any individual may in the future develop AIDS or ARC; or “(B) Take into consideration an individual’s use of HIV prevention treatment when taken pursuant to a valid prescriber’s order.”. (2) Subsection (c) is amended to read as follows: “(c) No health or disability insurance policy or contract shall contain any exclusion, reduction, other limitation of coverage, deductibles, or coinsurance provisions related to HIV prevention treatment or the care and treatment of AIDS, ARC, HIV infection, or any illness or ENROLLED ORIGINAL 3 disease arising from these medical conditions, unless the provisions apply generally to all benefits under the policy or contract.”. (c) Section 5 (D.C. Official Code § 31-1604) is amended as follows: (1) Subsection (a) is amended as follows: (A) Paragraph (1) is amended by striking the phrase “District of Columbia Commissioner of Public Health (“Commissioner”)” and inserting the phrase “Director of the Department of Health (“Director”)” in its place. (B) Paragraph (2) is amended by striking the word “Commissioner” and inserting the word “Director” in its place. (2) Subsection (b) is amended as follows: (A) Paragraph (1) is amended to read as follows: “(b)(1) A named insured who tests positive under the testing protocol certified by the Director may appeal to the Commissioner to review the testing procedures and results, and may present additional medical evidence, including the results of similar tests for exposure to the probable causative agent of AIDS that the named insured independently obtains, to rebut the positive test results. If the Commissioner determines that the result of the test of the proposed insured is not a true positive, the Commissioner shall order the insurer from which the applicant sought coverage to disregard the positive test result. The Commissioner shall, when necessary, request the advice of the Director in making this determination.”. (B) Paragraph (3) is amended by striking the word “Commissioner” and inserting the word “Director” in its place. (d) Section 9 (D.C. Official Code § 31-1608) is amended by adding a new subsection (b- 1) to read as follows: “(b-1) Any person who violates section 4 shall be fined not less than $1,000, and not more than $10,000 for each violation.”. (e) Section 10 (D.C. Official Code § 31-1609) is amended as follows: (1) The existing text is designated as subsection (a). (2) A new subsection (b) is added to read as follows: “(b) The Mayor, pursuant to Title I of the District of Columbia Administrative Procedure Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code § 2-501 et seq.), may issue rules to implement the provisions of section 12.”. (f) A new section 12 is added to read as follows: “Sec. 12. Coverage for HIV prevention treatment. “(a)(1) Except as otherwise provided in subsection (b) of this section, for health benefit plans issued or renewed on or after January 1, 2027, an insurer may not impose cost sharing, require prior authorization, or impose any medically unnecessary restrictions or delays for the coverage of HIV prevention services, PEP, or any formulation of PrEP. “(b) Subsection (a) of this section shall not apply to the extent that coverage without cost-sharing would disqualify an individual receiving coverage under a high deductible health plan from eligibility for a health ENROLLED ORIGINAL 4 savings account pursuant to 26 U.S.C. § 223. “(c) No health benefit plan or insurer may use prescription information indicating the use of HIV prevention treatment to medically underwrite premiums for specific enrollees. “(d) For the purposes of this section, the term “medically unnecessary restrictions” means step therapy, waiting periods, or preexisting condition exclusions.”. Sec. 3. The Department of Health Functions Clarification Act of 2001, effective October 3, 2001 (D.C. Law 14-28; D.C. Official Code § 7-731 et seq.), is amended by adding a new section 4907g to read as follows: “Sec. 4907g. DC Health and Wellness Center Fund. “(a) There is established as a special fund the DC Health and Wellness Center Fund (“Fund”), which shall be administered by the Department of Health in accordance with subsection (c) of this section. “(b) All payments made for services rendered at the DC Health and Wellness Center and affiliated clinics shall be deposited in the Fund, including: “(1) Payments received from third-party insurance reimbursements; “(2) Out-of-pocket payments collected from individuals; and “(3) Other collections. “(c) Money in the Fund shall be used solely to support the operations of the DC Health and Wellness Center and affiliated clinics. “(d)(1) The money deposited into the Fund, including any interest earned, but not expended in a fiscal year shall not revert to the unassigned fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time. “(2) Subject to authorization in an approved budget and financial plan, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation.”. Sec. 4. Fiscal impact statement. The Council adopts the fiscal impact statement in the committee report as the fiscal impact statement required by section 4a of the General Legislative Procedures Act of 1975, approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). Sec. 5. Effective date. This act shall take effect after approval by the Mayor (or in the event of veto by the ENROLLED ORIGINAL 5 Mayor, action by the Council to override the veto) and a 30-day period of congressional review as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)). ___________________________________ Chairman Council of the District of Columbia _________________________________ Mayor District of Columbia