NY| Supplement No. 3 to Insurance Circular Letter No. 21 (2017), from the New York State Department of Financial Services provides updated guidance on health insurance coverage for Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection.
Key points:
- Effective December 25, 2024, insurers are prohibited from requiring prior authorization for antiretroviral prescription drugs, including PrEP, that are on their formularies.
- Insurers must cover three FDA-approved PrEP formulations (two oral and one injectable) without cost-sharing for policies issued or renewed on or after February 29, 2024.
- Medical management techniques like step therapy are not permitted to direct individuals to use one PrEP formulation over another.
- Coverage must include specified baseline and monitoring services essential to PrEP’s efficacy, as recommended by the United States Preventive Services Task Force.
Click here to see Supplement No. 3 to Insurance Circular Letter No. 21 (2017)
