In October 2024, the Tri-Agency issued updated guidance on health plans’ coverage for HIV prevention. This law directs health plans to cover the three FDA-approved, HIV pre-exposure prophylaxis (PrEP) drugs without requiring any member cost-sharing or medical management. The requirement applies to plan or policy years starting after August 31, 2024.
The three FDA-approved medications are:
- Truvada (available as a generic)
- Descovy
- Apretude
Anthem plans already include zero cost-share coverage for generic Truvada and Apretude. Effective March 1, 2025, we will add zero cost-share coverage with no medical management for Descovy.
An additional requirement of the law is that this coverage is provided with no medical management restrictions (e.g. no prior authorization or step therapy directing choice among formulations).
If you have questions or need additional information about this change, please contact your Anthem representative.