Insights

New Regulation Requires PreP Coverage without Cost-Sharing


On January 12, 2022, Commissioner Conway adopted amendments to Regulation 4-2-73. This regulation applies to all carriers marketing and issuing individual and group health benefit plans subject to the state’s regulation. The regulation requires carriers to provide coverage for the federal Food and Drug Administration (FDA)-approved medication prescribed for pre-exposure prophylaxis (PrEP) without copayment or cost-sharing for individuals who, according to their provider or pharmacist, are indicated for PrEP. The amendments update the requirements for individual and group health benefit plans to provide coverage for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) as well as baseline and monitoring services.

Employers with plans regulated by the state should be aware of this development.

Regulation 4-2-73 »