The purpose of this memo is to announce the introduction of Pre-Exposure Prophylaxis (PrEP) Assistance Program (PrEP-AP) Immediate Access. PrEP-AP Immediate Access provides clients with 30 days of limited eligibility for limited coverage for PrEP or post-exposure prophylaxis (PEP).
PrEP-AP Immediate Access is a limited benefit that allows eligible clients to have 30 days of eligibility to have their PrEP/PEP-related medical costs paid for by PrEP-AP. Clients must enroll through the self-enrollment portal to receive coverage for this benefit. Once enrolled, clients can obtain a 30-day supply of PrEP/PEP through two points of access: telehealth or a clinical provider
PrEP-AP’s Immediate Access limited benefit will only cover the following:
- A max of 13 fills per year for PEP as long as the individual has temporary eligibility at the time of the dispense.
- Clients may receive two (2) thirty day-supplies of PrEP medication in a two-year period if they enroll into PrEP-AP utilizing Immediate Access through the self-enrollment portal. If individuals would like to continue on PrEP, they must meet PrEP-AP eligibility requirements and fully enroll into the PrEP-AP program.
- Clients may have their PrEP-related medical costs paid for by the PrEP-AP as long as the individual has temporary eligibility on the date of service.
- Uninsured clients are required to see a provider within the PrEP-AP Provider Network which includes PrEP-AP’s telehealth providers in order for the PrEP-AP to pay for both PrEP and PEP-related medical services.
Insured clients including those with private insurance or Medicare may access this benefit and must utilize their primary insurer for coverage. PrEP-AP will provide wraparound coverage for eligible out of pocket costs that are not covered. PrEP-AP is a payer of last resort.
To receive Immediate Access to PEP through PrEP-AP, the client must be:
- Assessed for PEP and have a prescription for PEP. PEP must be prescribed for a non-occupational exposure.
- Enrolled in PrEP-AP via the self-enrollment portal for 30 days of temporary eligibility with limited coverage.
- Have access to a pharmacy within the MagellanRx Network in California. Prescriptions for approved medications must be filled at a pharmacy in the Magellan network.
PrEP-AP Immediate Access is a limited benefit that does not include all allowable services under PrEP-AP, or all drugs on the PrEP-AP Formulary. Please also refer to the attached PrEP-AP Allowable PrEP Immediate Access Medical Services and PrEP-AP Drug Formulary for a list of medical services and drugs that PrEP-AP Immediate Access clients may access at a PrEP-AP Clinical Provider during their 30-day eligibility period.
The PrEP-AP Immediate Access Portal is now live and clients are able to use this portal to enroll into the program.
If you have any questions regarding this new PrEP-AP benefit or if you have any questions regarding the information provided in this memo, e-mail the PrEP-AP at PrEP.Support@cdph.ca.gov.
Sharisse Kemp, MSW
ADAP Branch Chief
California Department of Public Health