Medicaid Coverage For PrEP Without Restrictions, Cost Sharing Backed By President’s Budget

Legislation could facilitate faster access without cost sharing or restrictions for new HIV pre-exposure prophylaxis. The White House said its budget proposal to expand Medicare price negotiation would save $160bn more than the Inflation Reduction Act's existing negotiation provisions.

The PrEP Proposal Complements Plans For Broader Access To Hep C Drugs. • Source: Shutterstock

The Biden Administration supports legislation restricting the application of utilization management requirements and eliminating cost sharing for pre-exposure prophylaxis against HIV infection in Medicaid to expand the treatments' use.

The administration endorses action that “requires states to cover pre-exposure prophylaxis (PrEP) and associated laboratory services with no cost sharing for Medicaid and CHIP beneficiaries, and places guardrails on utilization management practices, like prior authorization and step therapy, that can pose barriers to access and utilization of PrEP,” according to the fiscal year 2024

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