AN ACT TO AMEND TITLE 18, TITLE 29, AND TITLE 31 OF THE DELAWARE CODE RELATING TO INSURANCE COVERAGE FOR TREATMENT TO PREVENT HIV INFECTION.
HB200, as substituted, requires Delaware health insurance coverage for medically necessary HIV prevention medications: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). The bill amends provisions in Title 18, Title 29, and Title 31 to require individual health insurance policies, group and blanket health plans, the state employee health plan, and Medicaid coverage for these medications when medically necessary. It also defines PrEP and PEP, and specifies that medically necessary use includes prescribing these medications to individuals at increased risk of HIV acquisition.
The bill bars cost-sharing for the required coverage, including deductibles, copayments, coinsurance, and out-of-pocket expenses, and prohibits prior authorization, step therapy, and unreasonable delays in coverage determinations. It includes exceptions and federal-law accommodations for certain limited policies, catastrophic plans, and high-deductible health plans where needed to preserve federal tax or plan status. The act applies only to policies and plans renewed, modified, altered, amended, or reissued after December 31, 2027, giving insurers time to adjust rates and coverage terms.
HB200 would expand Delaware insurance mandates by adding PrEP and PEP coverage requirements across private individual and group coverage, state employee health benefits, and Medicaid, while also amending related insurance code sections to align the mandate across multiple titles. It would affect insurers, health plans, state-administered coverage, and enrollees who may need HIV prevention treatment, and it would limit utilization management tools and patient cost exposure for these services. The delayed applicability date is intended to allow insurers to incorporate the new mandate into future filings and plan design.
The available voting history suggests strong support for the bill: it passed House Third Reading unanimously, 39-0. No committee transcripts were provided, but the substitute bill’s structure and synopsis indicate a policy goal of broadening access to HIV prevention medication while balancing implementation concerns through a delayed effective date and federal-law carveouts. Overall, the bill appears to have been received favorably and without recorded floor opposition in the available history.
The main policy tension in the bill is between expanding access to PrEP and PEP without financial or administrative barriers and preserving compatibility with federal insurance rules. The bill specifically addresses concerns about catastrophic plans, high-deductible health plans, and health savings account eligibility, which suggests insurers and plan administrators may have raised implementation or compliance issues. Another point of distinction is that the substitute narrows the original concept to coverage for PrEP and PEP medication only, indicating some refinement of scope before passage.