SA 1 to HS 1 for HB 200

This Amendment amends House Substitute No. 1 for House Bill No. 200, as amended by making all of the following changes: 1. Adding a definition of “essential services” which include testing and counseling services related to providing PEP and PrEP treatment. 2. Adding a definition of “FDA” to shorthand references, added by this Amendment, to the United States Food and Drug Administration. 3. Changing the definition of “medically necessary” to references the definition in Chapter 33, Subchapter II and Chapter 35, Subchapter V of Title 18, relating to pre-authorization transparency. The updated definition is commonly used for other health coverage mandates. 4. Adds a definition of “therapeutic equivalent” of a PrEP or PEP medication. 5. Adding medically necessary essential services to the list of required coverage. 6. Specifying that, if there are 1 or more FDA-approved therapeutic equivalent medications for a PEP medication or a PrEP medication, a health plan, policy, certificate, or contract is not required to cover all therapeutic equivalent versions of that PEP medication or that PrEP medication, so long as at least 1 therapeutic equivalent of that PEP medication and at least 1 therapeutic equivalent version of that PrEP medication is covered without cost-sharing, prior authorization, and step therapy requirements. For the purposes of the coverage requirement, a long-acting version of a PEP medication or a PrEP medication is not the therapeutic equivalent of another long-acting version of a PEP medication or a PrEP medication with a different duration 7. Allowing a health plan, certificate, policy, or contract to cover more than 1 therapeutic equivalent of a PEP medication or a PrEP medication and impose cost-sharing, prior authorization, and step therapy requirements, so long as at least 1 version of that PEP medication and at least 1 version of that PrEP medication in the same method of administration is covered without cost-sharing, prior authorization, and step therapy requirements. But a health plan, certificate, policy, or contract must provide a PEP medication or a PrEP medication without cost-sharing, prior authorization, or step therapy requirements, regardless of whether there is a therapeutic equivalent, if a covered individual’s or recipient’s treating health-care provider recommends that particular PEP medication or that particular PrEP medication based on a medical determination regarding that covered individual or recipient. 8. Changing the applicability date so that the coverage requirement applies to all policies, contracts, or certificates, that are issued, renewed, modified, altered, amended, or reissued after December 31, 2026.