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Defines coverage at zero dollar cost share for pre-exposure prophylaxis (PrEP) medications Descovy 200/25 mg, generic tenofovir 300 mg, brand Truvada 200/300 mg, and brand Viread 300 mg for UnitedHealthcare commercial plans; includes approval duration and default to standard plan coverage when criteria not met.
Added coverage for brand Truvada and brand Viread (11/2024).
Annual review (10/2023) updated criteria with no change to clinical intent.
Added Descovy strength indicated for PrEP (5/2022).
Updated references (2/2022, 12/2020).
Annual review (12/2025) noted no changes.
Defines coverage at zero dollar cost share for pre-exposure prophylaxis (PrEP) medications Descovy 200/25 mg, generic tenofovir fumarate 300 mg, brand Truvada 200/300 mg, and brand Viread 300 mg for UnitedHealthcare commercial plans. Authorization for zero copay with deductible bypass will be issued for 12 months when criteria are met; if zero dollar cost share criteria are not met the requested drug will default to standard plan coverage.
Zero dollar cost share coverage - Descovy or generic tenofovir
Covered when ALL of the following are met:
ALL of the following
Zero dollar cost share coverage - brand Truvada 200/300 mg
Covered when ALL of the following are met:
ALL of the following
Zero dollar cost share coverage - brand Viread 300 mg
Covered when ALL of the following are met:
ALL of the following
| Descovy 200/25 mg | emtricitabine/tenofovir alafenamide for PrEP |
| tenofovir fumarate 300 mg (generic) | tenofovir disoproxil fumarate generic formulation for PrEP |
| Truvada 200/300 mg (brand) | emtricitabine/tenofovir disoproxil fumarate brand |
| Viread 300 mg (brand) | tenofovir disoproxil fumarate brand |
Zero dollar cost share authorization
Authorization for zero copay with deductible bypass will be issued for 12 months when criteria are met; if criteria are not met the drug will default to standard plan coverage.
Provider attestation required for brand use
For brand Truvada or brand Viread, provider must attest that use of the generic (tenofovir disoproxil fumarate) is medically inappropriate.
Automated approval allowed
UnitedHealthcare may approve initial and reauthorization based solely on previous claim/medication history, diagnosis codes (ICD-10) and/or claim logic using automated processes that vary by program.
Primary guidance references: U.S. Preventive Services Task Force (USPSTF) recommendation on PrEP and the US Public Health Service/CDC PrEP clinical practice guideline (2021). This policy implements zero cost share coverage for PrEP in alignment with the USPSTF PrEP recommendation and the health care reform requirement for zero dollar cost share of PrEP medications.
Rationale: The USPSTF recommends prescribing PrEP to persons at increased risk of HIV to reduce acquisition risk, and health care reform requires PrEP medications be covered at zero dollar cost share. UnitedHealthcare implements this by providing zero copay coverage for specified PrEP medications under its commercial plans.
Program created (new program).
Updated references; clinical intent unchanged.
Added Descovy 200/25 mg strength indicated for PrEP (material change).
Annual review updated criteria with no change to clinical intent.
Program updated for book of business to include brand Truvada and brand Viread coverage at zero dollar cost share when criteria met (material change).
Annual review noted no policy changes.