USPSTF Recommendation

PrEP medication is available with no cost sharing for appropriate, eligible individuals1,2

How it may benefit the people you see:

As a result of the USPSTF Grade A recommendation, the Affordable Care Act (ACA) requires most plans* to cover medically appropriate PrEP medications, such as DESCOVY FOR PrEP®, and ancillary services with no out-of-pocket costs2

Ancillary services for PrEP medications, with no cost sharing, may include

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HIV testing

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HBV and HCV testing

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STI screening and counseling

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Renal testing

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Adherence counseling

*The ACA applies to all nongrandfathered private plans and Medicaid expansion plans.3

Help encourage appropriate coverage of HIV prevention care for individuals

If you become aware of an insurance plan that may not be acting in accordance with ACA requirements, there are measures you can take to help encourage appropriate coverage.

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Raise Awareness

Educate people who may benefit from PrEP medication that many health plans should provide coverage and zero co-pay or coinsurance for medically appropriate PrEP medications and ancillary services. Encourage individuals to contact their health plans for more information to understand their coverage.

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Take Action

If the individuals you see experience repeated coverage issues with the same health plan, advise them that they may contact their state insurance commissioner to advocate for no cost sharing when appropriate. PleasePrEPMe.org can also provide information resources aimed at helping appropriate individuals overcome medication access challenges.

Learn more at PleasePrEPMe.org
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Additional Resources

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Billing & Coding Reference

Learn more about ICD-10-CM and CPT® coding for preventive services to support individuals accessing certain PrEP medications and ancillary services with no cost sharing.

Download a convenient guide with HIV and other STI prevention and diagnostic codes
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Insurance Information Support

Advancing Access® may be able to help eligible individuals navigate their insurance coverage and determine if they may receive their prescribed DESCOVY FOR PrEP without cost sharing.

Explore the support offerings
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CPT=Current Procedural Terminology; HBV=hepatitis B virus; HCV=hepatitis C virus; ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification; STI=sexually transmitted infection.