Updated coverage for HIV PrEP medications
Beginning July 1, 2020, most of Anthem’s ACA-compliant, non-grandfathered health plans will cover pre-exposure prophylaxis (PrEP) medication at 100% with no member cost share, when used for prevention of HIV and dispensed at an in-network pharmacy with a prescription.
Since medications used for PrEP can also be used to treat HIV, we will review medical and pharmacy claims data to determine if a member has been diagnosed and prescribed treatment for HIV or prescribed PrEP for preventive purposes. When prescribed for prevention of HIV, this drug is covered with no member cost share. When prescribed for treatment of HIV, member cost shares apply based on the member’s benefit plan. Coverage includes Truvada (200-300 mg), and its generic components, Emtriva 200 mg and tenofovir 300 mg. When medically necessary, a prior authorization process is available for Descovy to be covered with no member cost share when used for prevention of HIV.
Providers can contact the provider service number on the back of the member ID card to determine if a member’s plan includes this benefit.
July 2020 Anthem Maine Provider News