In recognition of the evidence that the prescription medication PrEP (Truvada) is of substantial benefit for decreasing the risk of HIV infection in persons at high risk of HIV infection and in accordance with the NYS Insurance Law, beginning January 1, 2020, for New York Fully Insured and Minimum Premium non-grandfathered members.  Empire BlueCross BlueShield (“Empire”) began to cover PrEP medication at 100% when used for prevention of HIV and dispensed at an in-network pharmacy. Since PrEP can also be used to treat HIV, Empire 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 share applies pursuant to the terms of the member’s benefit plan.  This coverage includes Truvada and its components. 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.




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June 2020 Empire Provider News