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Departments Issue Guidance on PrEP Preventive Care Coverage
CheironLink to more items from this source
[Guidance Overview]
Aug. 5, 2021

"Plans may use reasonable medical management techniques to encourage individuals prescribed PrEP to use specific items and services, to the extent the frequency, method, treatment, or setting is not specified in the USPSTF recommendation. For example, since the branded version of PrEP is not specified in the USPSTF recommendation, plans may cover a generic version of PrEP without cost sharing and impose cost sharing on an equivalent branded version. However, plans must accommodate any individual for whom a particular PrEP medication (generic or brand name) would be medically inappropriate[.]"

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