HIV Prevention Drugs - Prescribing, Dispensing, and Insurance Coverage
HB1114 would expand access to HIV prevention medications in Maryland by allowing pharmacists, under Board-approved training and regulations, to prescribe and dispense preexposure prophylaxis (PrEP) to patients. The bill also defines PrEP and postexposure prophylaxis (PEP) for purposes of state law, requires pharmacist counseling and follow-up notification or referral, and directs the State Board of Pharmacy to develop training-related notification plans and convene a workgroup to consider broader pharmacist authority, including collaborative practice agreements or a statewide protocol for assessing patients, ordering labs, and prescribing PrEP.
The bill also changes coverage rules for public and private insurance. Beginning January 1, 2027, the Maryland Medical Assistance Program would have to cover FDA-approved HIV prevention drugs, including PrEP and PEP, subject to budget limits. Managed care organizations, insurers, nonprofit health service plans, and health maintenance organizations would be barred from imposing prior authorization, step therapy, or cost-sharing for PrEP and PEP, and from charging cost-sharing for related medically necessary services such as HIV testing, kidney function testing, follow-up monitoring, pregnancy testing, office or telehealth visits, hepatitis testing, STI testing, and hepatitis B vaccination.
HB1114 would amend the Health – General, Health Occupations, and Insurance Articles to create a new pharmacist prescribing/dispensing authority for PrEP, establish statutory definitions for HIV prevention drugs and CDC guideline references, and impose new coverage mandates on Medicaid, managed care organizations, and private carriers. It would also extend the anti-prior-authorization and anti-cost-sharing rules to related clinical services tied to PrEP and PEP, affecting insurers, pharmacy benefit arrangements, Medicaid, and pharmacy practice standards statewide.
Based on the bill text and available context, the measure appears generally supportive of expanding HIV prevention access and reducing administrative and financial barriers to care. The bill’s structure emphasizes implementation through training, counseling, and stakeholder consultation, suggesting an effort to balance access with clinical oversight. No committee transcript or recorded votes were provided, so there is no documented opposition or support beyond the bill’s sponsor list and policy design.
The main points of potential contention are likely to be the expansion of pharmacist scope of practice, the prohibition on prior authorization, step therapy, and cost-sharing, and the requirement that insurers cover related services without patient cost-sharing. Stakeholders concerned about provider oversight, lab ordering, collaborative practice authority, or insurance utilization management may question these provisions, while public health advocates and HIV prevention stakeholders are likely to support them. The bill also leaves some implementation details to the State Board of Pharmacy and future workgroup recommendations, which may be another area of debate.