[This column appears in the Sept./Oct. 2026 print issue of Boston Spirit magazine, New England’s premier LGBT magazine. Sign up for a free subscription at the end of this article.]
For decades, the fight against HIV has followed a familiar pattern: groundbreaking science followed by battles over access. Be it the first HIV treatments that offered hope during the epidemic’s darkest years or the combination therapies that later transformed HIV from a death sentence into a manageable chronic condition, each scientific breakthrough has been met with legal, political and financial barriers that kept too many people from benefiting. PrEP is no different.
In July, Governor Maura Healey signed landmark legislation making Massachusetts the first US state to comprehensively protect access to HIV pre-exposure prophylaxis, or PrEP, in state law. By codifying no-cost insurance coverage and eliminating unnecessary barriers to this medication, the Commonwealth has refused to let access lag behind science. Protecting public health isn’t simply a matter of scientific innovation; it requires political will. As the federal government defunds and dismantles critical HIV prevention programs, Massachusetts created a model every state should follow.
Since being approved in 2012, PrEP has transformed HIV prevention, reducing the risk of sexual transmission to nearly 100 percent when taken as prescribed. Now, a new long-acting injectable form of PrEP requires just two doses a year. These advances are bringing the country closer than ever to eradicating HIV.
But scientific breakthroughs alone don’t end epidemics. They must be reinforced by laws that protect patient access from discriminatory actions, unnecessary bureaucracy and political interference.
Even in Massachusetts, only about 35 percent of people eligible for PrEP currently have an active prescription. Cost-sharing, deductibles, prior authorization, insurance bureaucracy, provider inexperience, stigma and unequal access to health care can keep many people from accessing a medication that could prevent lifelong infection. Those barriers are most acutely felt in communities already bearing the greatest burden of HIV. Nationally, just 13 percent of eligible Black people and 24 percent of eligible Latino people receive PrEP, compared with 94 percent of eligible white people.
Massachusetts’ new law, passed thanks to the leadership of House Ways and Means Chairman Aaron Michlewitz, Senate Ways and Means Chair Michael Rodrigues, House Majority Leader Michael Moran, Speaker Mariano, Senator Cindy Friedman, Senate Chair of the Joint Committee on Health Care Financing and bill sponsors Senator Julian Cyr and Representative Jack Patrick Lewis, aims to remove those barriers.
The legislation guarantees that private insurance, MassHealth, and the Group Insurance Commission cover every FDA-approved PrEP medication without copays, deductibles, prior authorization or unnecessary insurance obstacles. It also recognizes that access requires meeting people where they are.
The law requires correctional facilities to offer PrEP to eligible individuals before release—including long-acting injectable PrEP—and builds on previous legislation authorizing pharmacists to prescribe a time-limited supply of the medication. Together, these provisions make it easier for people at heightened risk of HIV to obtain prevention when it matters most.
Massachusetts couldn’t have acted at a more critical moment. For years, federal law has required insurers to cover PrEP without cost-sharing because the US Preventive Services Task Force gave the medication its highest recommendation. Federal guidance has likewise prohibited prior authorization for FDA-approved PrEP. But those protections are no longer guaranteed after a 2025 Supreme Court decision gave the Secretary of Health and Human Services unprecedented authority over the Task Force—the independent panel of physicians, nurses and public health experts whose evidence-based recommendations determine which preventive services insurers must cover without cost-sharing.
Secretary Robert F. Kennedy Jr. has already begun reshaping the Task Force, firing two of its vice chairs, leaving vacancies unfilled, and disrupting its work through canceled meetings. Public health experts have warned that replacing independent scientific judgment with political interference could jeopardize recommendations for preventive services—including PrEP—that millions of Americans rely on for insurance coverage.
Massachusetts responded by locking those protections into state law. By ensuring continued no-cost access to PrEP regardless of future federal decisions, the Commonwealth has protected both public health and the promise of finally ending the HIV epidemic.
Massachusetts has shown that protecting access to HIV prevention is a choice. States can leave lifesaving care vulnerable to shifting, unscientific political agendas, or they can enshrine evidence-based protections in state law.
Massachusetts chose not to repeat the fraught history of HIV treatment and prevention, where scientific breakthroughs were too often followed by battles over access. Now other states face that same choice. Every day they fail to act, more people are denied access to a medication that can prevent HIV altogether.
More: gladlaw.org