AmeriHealth Market Edge Article
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October 2021
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Market Edge
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News for All Segments | All brands
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PrEP preventive coverage and monitoring services now $0
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Effective September 18, 2021, all services received by members prior to beginning pre-exposure prophylaxis (PrEP) medication for the prevention of HIV and any ongoing follow up or monitoring are now covered at $0.
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The U.S. Preventive Services Task Force (USPSTF) issued a final recommendation statement on the prevention of HIV infection using PrEP in 2019, and the drug gained $0 cost‑share coverage in July 2020.
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On July 19, 2021, the Departments of Labor, Health and Human Services, and the Treasury jointly issued a clarification on the preventive coverage for PrEP as recommended by the USPSTF. In accordance with the clarification, certain services received by a member prior to beginning PrEP and monitoring services, which are essential to the efficacy of PrEP, are to be considered preventive. This is consistent with the 2017 Centers for Disease Control and Prevention (CDC) guidelines on the use of PrEP for the prevention of HIV infection.
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These services are:
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- HIV testing
- Hepatitis B testing
- Hepatitis C testing
- Creatinine testing and calculated estimated creatine clearance (eCrCl) or glomerular filtration rate
- Pregnancy testing
- Sexually transmitted infection (STI) screening and counseling
- Adherence counseling
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For more information about this coverage, please reference the medical policy bulletin for AmeriHealth Administrators and AmeriHealth New Jersey.
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