January 09, 2018
On Dec. 1, 2017, the New York State Department of Financial Services (DFS) published Insurance Circular Letter No. 21 (2017). The new bulletin relates to health insurance coverage for pre-exposure prophylaxis (PrEP) for HIV prevention. As background, DFS has received complaints that carriers may be imposing barriers to access PrEP, which is a prescription drug used for the prevention of HIV infection. The DFS states that some of those barriers include use of stringent preauthorization requirements and improper denials of coverage. According to the bulletin, coverage of PrEP should be subject only to reasonable utilization management measures and must follow written clinical review criteria in a nondiscriminatory manner. Specifically, there’s no justification for denying coverage for PrEP on the ground that the patient is at risk for HIV based on his or her sexual orientation.
The letter contains no new employer obligations, but employers should be aware of the coverage requirements relating to PrEP, should they come up with the carrier or should employees have questions.
Insurance Circular Letter No. 21 »