PrEP Works. The States Must Protect Access.

Thanks to PrEP (pre-exposure prophylaxis), we’re closer to stamping out HIV than we’ve ever been.

[Update: Since this article was published, MA has passed historic protections for PrEP access.]

There remains, however, a critical need to ensure this powerfully effective preventive medication is accessible to everyone at risk for HIV, especially now that potential federal regulatory changes could put PrEP further out of reach. GLAD Law is redoubling efforts to protect and expand access to PrEP at the state level, most recently in Massachusetts.

It’s impossible to overstate the potential for PrEP to eradicate HIV. Last year, the FDA approved a long-acting, twice-yearly injectable form (known commercially as Lenacapavir or Yeztugo) that has proven so effective in preventing HIV infections through sex or injection drug use that the journal Health Affairs calls it “a functional vaccine against HIV.” Just two shots yearly from a doctor or pharmacist provide full protection; a once-a-year shot is expected soon. 

PrEP has been available since 2012, but even in Massachusetts, long a leader in HIV prevention, only about 35% of those eligible to receive PrEP have an active prescription. Deep racial disparities, HIV stigma, cost barriers, health care bureaucracy, and inadequate insurance coverage prevent many of the people most at risk for HIV from accessing PrEP.

GLAD Law has been working for several years to pass state laws to overcome these barriers to access. Now, the need for state leadership is increasingly urgent.

Under current federal law and rules, insurance plans are required to cover PrEP, including injectable PrEP, at no cost and without prior authorization. The Affordable Care Act mandates free coverage for effective preventive services and medications, like PrEP, that are recommended by the US Preventive Services Task Force (USPSTF). And federal guidance prohibits prior authorization for PrEP medications.

Those protections are now at risk because a 2025 Supreme Court decision gave the Secretary of Health and Human Services significant new power over the USPSTF. The Secretary can now appoint, remove, and override that panel’s decisions at will.

This means the current administration could roll back PrEP’s no-cost coverage requirement and reverse at will the prior authorization guidelines – resulting in out-of-pocket costs, new insurance hurdles, and increased obstacles to PrEP access. 

GLAD Law is supporting legislation advanced in the Massachusetts House budget that codifies into state statute the current federal law and policy requiring insurance coverage for all FDA-approved PrEP medications without co-pays, deductibles, or prior authorization. Like Massachusetts’ recent action to decouple vaccine approval provisions from the federal framework, this measure takes the same step with respect to PrEP. If passed in the Senate and signed into law, it will help prevent a decline in utilization and realize the promise of PrEP to eradicate HIV.

We’re grateful to Massachusetts House leadership, including Speaker Ron Mariano, House Ways and Means Chair Aaron Michlewitz, and Majority Leader Michael Moran, as well as House and Senate bill sponsors Representative Jack Lewis and Senator Julian Cyr, for recognizing that we cannot rely on a federal government that has shown hostility to HIV prevention and public health; Massachusetts must act now.

Preventing HIV isn’t just about medical advances; it is a policy choice. When cost, stigma, bias, red tape, and political agendas stand between people and prevention, infections rise. When access is simple, affordable, and widespread, infections fall.

“PrEP is our best opportunity to end the HIV epidemic, but that potential only matters if people can actually get it,” said Ben Klein, Senior Director of Litigation and HIV Law. “Right now, federal actions are putting that access at risk. States have the power to step in and codify coverage for PrEP without cost and prior authorization barriers. Massachusetts continues to be a national leader to ensure that this lifesaving prevention reaches everyone who needs it.”

This story was originally published in the Summer 2026 GLAD Law Briefs newsletter. Read more.