Truvada, the drug commonly used for Pre-Exposure Prophylaxis (PrEP), is included on the medication formulary of all insurance plans in Arizona: private, commercial, public (Medicare and Medicaid), and Federally Facilitated Marketplace (FFM) plans. Some of the plans will require a prior authorization (PA) for Truvada to be used as PrEP, as opposed to treatment for HIV, and/or authorization for a patient to receive PrEP clinical management by a specialty provider instead of a primary care provider. While PrEP is covered by insurance, coverage varies widely by plan. This document will review Federally Facilitated Marketplace (FFM) insurance plans and provide examples of the initial and yearly out-of-pocket maximum costs an individual can expect to pay for PrEP under each of these plans in Pima County, Arizona. In addition, this document will review PrEP coverage under private, commercial and public insurers.
Download the full report here: PrEP Health Plan Assessment 1.8.16