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Transmittal 23-22 - Antiretroviral (ARV) Drug Coverage Clarification


Monday, April 24, 2023

This transmittal outlines the coverage of Antiretroviral (ARV) drugs prescribed and dispensed to treat or prevent HIV for enrollees of the District’s Fee-for-Service (FFS), Medicaid managed care, and DC Health Care Alliance (Alliance) programs. This transmittal builds on previous guidance from the Department of Health Care Finance (DHCF) and provides streamlined information regarding benefit eligibility, including eligibility for newborns, prescription filling, claim adjudication, and reimbursement for ARV drugs. This transmittal also helps facilitate timely access to HIV treatment, Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP).