Senate approves bill requiring insurers to cover PrEP and PEP without barriers

The Delaware Senate on June 24 approved House Substitute 1 for House Bill 200, requiring insurers, the state employee health plan and Medicaid to cover two HIV-prevention medications — pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) — without cost-sharing, prior authorization or step-therapy requirements when a treating provider deems a specific medication medically necessary.

Senator Sarah Pinkney, sponsor of the Senate amendment, said the amendment preserves the bill’s intent while adding clarity and implementation flexibility. "The amendment clarifies that coverage for PrEP and PEP includes essential support services necessary for safe and effective treatment — including HIV, hepatitis and kidney-function assessments — and adopts a standard definition of ‘medically necessary,’" Pinkney said on the floor.

The amendment also defines "therapeutic equivalent," clarifies that health plans are not required to cover every FDA-approved equivalent medication, and protects patients by ensuring that if a treating provider determines a particular medication is medically necessary, that medication must be covered without cost sharing or prior authorization. The amendment moves the bill’s effective application date to policies issued, renewed or amended after Dec. 31, 2026.

Senators voted to adopt the Senate amendment and then took a roll call on the amended bill. The secretary recorded 21 yes votes; having received the required majority, the Senate declared House Substitute 1 for HB200 (as amended) passed.

The change aims to reduce barriers to rapid access to PEP — which must be initiated within 72 hours after possible exposure — and to standardize coverage of PrEP. The bill’s sponsors said it will align plan benefits and remove administrative hurdles that can delay time-sensitive treatment.

Next steps: the bill, as amended and passed by the Senate, will be returned to the House as required by legislative procedure.