Your Experience is a Gift

We feature real stories from people who have chosen to use PrEP as one way to protect themselves from HIV. If you have used or are using PrEP, we invite you to share your PrEP experience via audio, video, or in writing. Send video or audio links and/or text to myprepexperience@gmail.com and we will post them here. You can include your name, or you may contribute your story anonymously. This blog also contains helpful information on PrEP for users, potential users, and providers. Look for the links in the sidebar.

We have not heard of any insurance company or any Medicaid program outright denying coverage of Truvada as PrEP. Some companies and programs are requiring prior-authorization, however, which requires paperwork to be filled out. And the type of insurance coverage you have, including prescription drug benefits, will determine the cost to you as the consumer. To date, we have seen the biggest barrier to obtaining PrEP from providers who are unwilling to write a prescription.

If you have trouble getting a prescription for Truvada as PrEP from your provider, or getting a PrEP prescription covered by insurance or Medicaid, we are happy to troubleshoot with you. Send us an email to myprepexperience@gmail.com.

Truvada Track - monitoring insurance and Medicaid coverage of Truvada for PrEP

Truvada Track - monitoring insurance and Medicaid coverage of Truvada for PrEP
 

This page monitors insurance and Medicaid coverage of Truvada as PrEP, and shares information on payment options. It will be updated frequently. The most current update is at the top. If you have information about insurance or Medicaid coverage of Truvada for PrEP - including pre-authorization requirements, denials, or other payment options - please share this information with us by sending an email to myprepexperience@gmail.com.  
As of December 18, 2013 - we have not heard of one case in which an insurance company or a Medicaid program refused to cover Truvada as PrEP. Insurance companies and Medicaid programs - so far - are covering the cost of Truvada as PrEP. 
That said, we are more than happy to help you advocate for access should you be denied a PrEP prescription from your healthcare provider or denied coverage from your insurance company.

August 21, 2013 update

Fact sheet: Pharmaceutical Company Patient Assistance Programs and Co-Payment Assistance Programs for Pre-exposure Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP). This helpful new resource on PrEP and PEP payment options (hotlinked above) was released today by NASTAD (National Alliance of State and Territorial AIDS Directors.) Check it out.


July 1, 2013 update
 
 
Letter from United Healthcare regarding pre-authorization requirements for Truvada as PrEP.

Pre-authorization requirements for Truvada as PrEP from United Healthcare.
 
• UnitedHealthcare (commercial insurance): Prior authorization required, consistent with indication on label, triggered when Truvada is prescribed without a third agent or in the absence of code for HIV infection (see pictures above.) Click here for the UnitedHealthcare document that provides information on their coverage criteria for Truvada as treatment, as PEP, and as PrEP.

• Aetna (commercial insurance): Prior authorization required, consistent with indication on label, triggered when Truvada is prescribed without a third agent or in the absence of code for HIV infection

• Florida Medicaid: Prior authorization required, consistent with indication on label, triggered when Truvada is prescribed without a third agent or in the absence of code for HIV infection
 
• New York Medicaid: Prior authorization requires documented HIV- test result; triggered when Truvada is prescribed without a third agent or in the absence of code for HIV infection
 
• Catamaran (pharmacy benefit management – select clients only): As of 6/25/13 – reports from health care providers of prior authorization impacting new starts on Truvada to confirm diagnosis (treatment vs. PrEP). Appears to allow PrEP use when consistent with label.

Notes:


  • Up to July 1, we have not heard of denials of coverage. But pre-authorization requirements, many of which are just starting on July 1, could potentially lead to denial of coverage for Truvada as PrEP. 
  • "Without a third agent" - Truvada is a combination of  2 drugs, and appropriate treatment for people living with HIV consists of 3 or more drugs. So, when Truvada is prescribed and a third "agent" is not, this signals that Truvada is being prescribed as PrEP.
  • United Healthcare is the largest insurer in the U.S., and we understand that approximately 300 of their members (out of a total in the millions) are currently taking Truvada without a third agent. A very, very small percentage of HIV-negative people for whom they provide insurance.


Questions, concerns, or clarifications - send email to myprepexperience@gmail.com

 

4 comments:

  1. This is a great resource guys! Have been looking for this information as I will be shopping for health insurance soon and was wondering if they are covering it and how does it work. thanks!

    ReplyDelete
  2. Glad this is helpful! Keep us posted!

    ReplyDelete
  3. On the phone with Aetna as I type this trying to get our co-pay of $910/month each to something more affordable. This sight has given me some terminologies I can use to try to argue my point. Thanks!

    ReplyDelete

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