Committee hears bill to codify Medicaid coverage of HIV antivirals without prior authorization or step therapy
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Summary
Senate Bill 5,577 would codify an existing Health Care Authority policy (from the 2023 budget) to cover all FDA-approved HIV antivirals and pre-exposure prophylaxis in Medicaid without prior authorization or step-therapy requirements, advocates told the committee.
Senate Bill 5,577 would codify Medicaid coverage for all FDA-approved HIV antiviral drugs and pre-exposure prophylaxis (PrEP) without prior authorization or step-therapy requirements, the House Health Care & Wellness Committee heard March 14.
Committee staff explained the budget-directed policy in 2023 that already removed prior authorization requirements for these medications; the bill would place that policy into permanent statute and also prohibit step-therapy mandates.
Katie Cole of the AIDS Healthcare Foundation and David Ramos of Cascade AIDS Project testified in support, saying ready access to clinically appropriate antiviral regimens preserves continuity of care, respects individual clinical needs (drug resistance and side-effect profiles) and supports HIV-prevention goals by allowing viral suppression and PrEP access. Ramos emphasized equity concerns, noting marginalized communities are disproportionately affected by HIV and more likely to be insured through Medicaid.
Proponents urged the committee to take executive action; the hearing closed with no recorded vote.