This is what we at Men’s Health Foundation have been informed of:

 

Effective 7/1, Truvada for PrEP (monotherapy) will require a prior authorization for United Healthcare Commercial members.  Truvada for HIV treatment will continue to be covered with no restriction.   For your reference, United Healthcare Truvada PrEP PA form is available at: https://professionals.optumrx.com/content/dam/optum3/professional-optumrx/resources/pdfs/UHCEnI/Truvada_UHC.pdf

 

In addition, effective 7/1, United Healthcare Commercial members may be required to use United’s preferred specialty pharmacy, BriovaRx, to fulfill Truvada PrEP prescription. For your reference, HIV Pre-Exposure Prophylaxis (PrEP) Enrollment Form is available at: https://briovarx.com/enrollmentForms.html

Prior Authorization Criteria:

United’s Truvada for PrEP prior authorization criteria will mirror its REMS requirement:

  1. Patient has been determined to be at high risk for HIV-1 infection -AND-
  2. Patient has received counseling on safe sex practices and HIV infection risk reduction. -AND-
  3. Patient has no clinical symptoms consistent with acute viral infection -AND-
  4. Patient has a confirmed negative HIV-1 status within the past 2 weeks

Authorization will be issued for 3 months, with reauthorization requirement every 3 months.

However, it is also our understanding that UHC patients will be able to opt-out of having to use BriovaRx specialty pharmacy similar to how they are able to opt out for HIV treatment meds and use their current pharmacy. Please click on this link for a recent article and more clarification: http://www.thebody.com/content/80045/prep-user-on-united-healthcare-heres-how-to-keep-y.html

 

Best,

 

Brian

BRIAN RISLEY, MFA

Director, Programs & Education

Men’s Health Foundation

9201 W Sunset Blvd, Suite 814

Los Angeles, CA 90069

310.550.1014 (Office)

310.550.0650 (Fax)

www.mhfoundation.org