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Journal Club

November 27, 2019


PrEP Updates from HIVMA

PrEP Access Expansion Program Set to Launch

The Department of Health and Human Services is aiming for a December start for its program to provide free PrEP to uninsured individuals at substantial risk for HIV across the United States. Once launched, the program will be available nationwide to patients who are uninsured, have a negative HIV test and have a prescription for PrEP. The agency has released this fact sheet on the program, which will support the goals of the federal Ending the HIV Epidemic initiative.

In addition, HIVMA has produced these answers to frequently asked questions about the initiative, and this fact sheet on PrEP policy considerations to achieve the promise of the USPSTF “A” recommendation for coverage of the prevention measure.

UnitedHealthcare Requires Prior Authorization for Descovy for PrEP

As of mid-November, UnitedHealthcare is requiring prior authorization for Descovy when prescribed for PrEP. Providers can request coverage through a verbal or electronic communication that indicates the patient has a contraindication or prior intolerance to Truvada. Patients already on Descovy for PrEP as of Nov. 14 will not require prior authorization, and no action will be required by the patient or their care provider to continue accessing Descovy. Truvada for PrEP will not be subject to prior authorization.

The prior authorization does not apply to Descovy prescribed for treatment. For patients who have claims for other antiretroviral medications, Descovy should process without requiring prior authorization. For patients who do not have other antiretroviral medication claims in their history, the care provider will need to complete a prior authorization noting that Descovy is being used for treatment.

Please email HIVMA staff with questions or if you encounter issues with the prior authorization process.

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