On September 1, 2021, the Department of Insurance issued Bulletin No. 2021-09 to alert carriers to recent federal guidance regarding coverage requirements for HIV Pre-exposure Prophylaxis (PrEP) without cost-sharing. The bulletin was directed at carriers writing insurance in the state.
The US Preventive Services Task Force made recommendations regarding coverage of PrEP as preventive services to decrease the risk of HIV transmission for persons who are at high risk of HIV infection. The recommendation encompasses not only the drug itself, but also the ancillary tests and services to begin and maintain a PrEP prescription. These baseline and monitoring services include HIV testing, hepatitis B and C testing, creatinine testing and calculated estimated creatine clearance or glomerular filtration rate, pregnancy testing, sexually transmitted infection screening and counseling and adherence counseling.
Accordingly, the bulletin recommends that carriers update their websites to reflect the scope of the PrEP coverage provided as preventive services without cost-sharing. Carriers are also advised to provide enrollees with information clarifying the coverage and to provide a copy of the communication to the department.
The bulletin notes that federal regulators have given insurers until September 19, 2021 to provide this coverage and that the department will adhere to this implementation date.
Although the guidance is directed at insurers, employers that sponsor group health plans may also want to be aware of these preventive service coverage requirements.
Bulletin No. 2021-09 »