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NYS Medicaid Pharmacy Programs

HIV-1 Pre-Exposure Prophylaxis (PrEP) agents

HIV-1 Pre-Exposure Prophylaxis (PrEP) agents

Prior Authorization Call Line: 1-877-309-9493

Prior Authorization Fax Line: 1-800-268-2990

Prior authorization of HIV-1 Pre-Exposure Prophylaxis (PrEP) agents has been implemented to reinforce appropriate use and to ensure utilization consistent with approved indications. Requests for prior authorization of HIV-1 PrEP agents can be initiated by either prescribers or their authorized agents. An authorized agent is an employee of the prescribing practitioner and has access to the patient's medical records (i.e. nurse, medical assistant).

HIV-1 PrEP agents:

  • emtricitabine/tenofovir disoproxil fumarate (Truvada®)
  • emtricitabine/tenofovir alafenamide (Descovy®)

Prior authorization requirements:

  • HIV-1 PrEP agents may require prior authorization under the Clinical Drug Review Program (CDRP).
  • Prescribers or authorized agents are required to respond to a series of questions that identify the prescriber, the patient and the reason for prescribing an HIV-1 PrEP agent.
  • Prescribers or authorized agents must indicate whether the HIV-1 PrEP agent has been prescribed for HIV pre-exposure prophylaxis (PrEP) or treatment of HIV/AIDS. If the agent has been prescribed for prophylaxis, the date of last negative HIV test must also be provided.
    • During the Declared Disaster Emergency in the State of New York due to COVID-19, HIV testing requirements have been relaxed to accommodate access.