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Transmittal 21-13 PrEP and PEP Coverage for Medicaid Beneficiaries Enrolled in MCOs

Thursday, March 18, 2021

This is to inform you that the DC Department of Health Care Finance (DHCF) is implementing a policy change that will carve-out coverage and reimbursement for medications approved for HIV pre-exposure prophylaxis (PrEP) and for HIV post-exposure prophylaxis (PEP) from the Medicaid managed care program. The managed care organizations (MCOs) will no longer reimburse for these medications through the DC Healthy Families Program (DCHFP). This policy does not apply to individuals enrolled in the DC Healthcare Alliance (Alliance) or the Immigrant Children’s Program (ICP).