The purpose of this Management Memorandum is to notify PrEP-AP enrollment workers of steps being taken by the California Department of Public Health (CDPH), Office of AIDS (OA) to maintain PrEP-AP coverage and to minimize the exposure of PrEP-AP clients to novel coronavirus, also known as COVID-19.
Emergency Eligibility Extensions for Existing PrEP-AP Clients
PrEP-AP is extending eligibility to June 30, 2020 for all clients whose eligibility expired, or will expire, between March 1, 2020 and June 29, 2020. This extension will be done entirely within the ADAP Enrollment System (AES). PrEP-AP enrollment workers are encouraged to reach out to clients with eligibility expiring between now and June 30, 2020 to inform them of these changes.
Clients Enrolled in a Gilead Assistance Program
Gilead is not extending eligibility for clients enrolled in Gilead's Patient Assistance Program at this time. Clients enrolled in the Patient Assistance Program with expiring eligibility should submit a re-enrollment application with income documentation through Gilead's online portal or by fax to 1-800-216-6857 prior to their eligibility ending to prevent a lapse in coverage.
If clients are unable to obtain their medication or submit a re-enrollment application before their eligibility expires, Gilead can provide the pharmacy an override on a case-by-case basis. The pharmacy should contact Gilead at (800) 226-2056 for an override. If Gilead does not allow a PrEP medication dispense, PrEP-AP may approve an override on a case-by-case basis for eligible clients. Clients in these circumstances are to have their pharmacy contact Magellan Rx for an override dispense of PrEP. CDPH has informed Magellan Rx of this temporary process.
In addition, clients enrolled in Gilead's Patience Assistance Program and Gilead's Copayment Assistance Program can receive up to a 90-day fill of medication as long as the client has eligibility throughout the duration of the 90-day time period. Clients enrolled in Gilead's Copayment Assistance Program can only receive a 90-day dispense if the client's insurance allows for a 90-day prescription fill. Pharmacies must contact Gilead to obtain an override code. This is currently in effect until April 30, 2020.
Please Note: Re-enrollment is not required for the Gilead Copayment Assistance Program.
Telemedicine and Alternatives to In-Person Visits
The Office of AIDS is encouraging PrEP-AP clinical providers to consider converting PrEP clinical and other visits to virtual (telephone or video) if their agency has the capacity. The PrEP-AP can reimburse for clinical services provided with telemedicine using the same billing codes that would have been used for an in-person visit. Clinical providers are also being encouraged to proactively reach out to clients by phone, text, or email (depending on their agency's policy) to inform them that in-person appointments are being rescheduled to telemedicine appointments.
Clinical providers are also being asked to postpone services that require person-to-person interactions but will continue to maintain access to in-person visits when needed based on the client's symptoms, such as symptoms of acute HIV or a sexually transmitted infection. Lastly, laboratory testing for people on PrEP with good adherence and no symptoms can usually be postponed for 3 months.
The PrEP-AP will continue to monitor the situation and make further adjustments as needed. Up to date information on COVID-19 in California is available at www.cdph.ca.gov/covid19. If you have any questions regarding the contents of this Management Memorandum, please email the PrEP-AP inbox at PrEPSupport@cdph.ca.gov.
Sandra Robinson, MBA
ADAP Branch Chief
California Department of Public Health