Bill > HB200

This bill mandates that all individual and group health insurance policies in Delaware must cover treatments to prevent HIV infection, specifically pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications, along with medically necessary "essential support services" such as HIV and hepatitis testing, kidney function assessments, pregnancy testing, and counseling for sexually transmitted infections and adherence. These treatments and services must be covered without any cost-sharing requirements (like deductibles or copayments), prior authorization, or step therapy requirements, which are processes where a less expensive drug must be tried first. However, there are exceptions: if the U.S. Food and Drug Administration (FDA) has approved multiple versions of a PrEP or PEP that are considered "therapeutically equivalent" (meaning they are essentially the same drug in the same dosage and form), an insurance plan doesn't have to cover every single version without these requirements, as long as at least one version of each is covered without them. Additionally, if a healthcare provider recommends a specific PrEP or PEP for a patient due to medical reasons, that specific medication must be covered without these requirements, even if other therapeutically equivalent options exist. The bill also clarifies that these new coverage requirements do not apply to certain limited health insurance policies like accident-only or long-term care plans, and there are specific provisions for high-deductible health plans and catastrophic health plans to ensure they remain compliant with federal law. This Act will take effect for policies issued, renewed, modified, or reissued after December 31, 2026.