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 firstname.lastname@example.org.
As of April 20, 2015 - 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.|
• 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.
- 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 email@example.com