Preventive Care – HIV Preexposure Prophyaxis (PrEP)
In accordance with Carrier Letter 2025-01, USPSTF A and B recommendations, the Affordable Care Act (ACA) and Women’s Health and Cancer Rights Act Implementation Part 68, SAMBA provides coverage for the three FDA approved HIV Preexposure Prophylaxis (PrEP) drugs for persons who are at high risk of HIV acquisition at no cost to FEHB (and EGWP) members. Our HIV PrEP benefit also provides coverage for applicable baseline and follow-up testing and monitoring, including HIV testing every 2 to 3 months without cost-sharing, when administered by an in-network provider.
The chart below indicates how the following drugs for PrEP are covered.
| Drug | Available at zero cost share Y/N | Subject to utilization management (UM) edits Y/N (Indicate type of edit if applicable) | Subject to deductibles Y/N | Subject to annual limits Y/N |
| Generic Truvada (emtricitabine/tenofovir disoproxil fumarate) | Y | N | N | N |
|
Descovy (tenofovir alafenamide/emtricitabine) |
Y |
Y Member pays regular copay and then can request (UM) review. If it’s confirmed that the member meets the ACA/PrEP criteria, then they are reimbursed the copay with future fills are at zero cost. |
N | N |
| Apretude (cabotegravir) |