Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)

Program Summary

On June 29, 2014, Governor Cuomo announced a three-point plan to end AIDS as an epidemic in New York State. The goal of the initiative is to decrease new HIV infections to the point where, by 2020, the number of persons living with HIV will be reduced for the first time. Point three of the Governor’s plan is, “Providing access to Pre-Exposure Prophylaxis for high-risk persons to keep them HIV negative.”

Pre-Exposure Prophylaxis (PrEP) is an HIV prevention method in which people who do not have HIV take a daily pill (HIV antiretroviral medication) to reduce their risk of becoming infected. Based on studies showing significant reduction in HIV acquisition among HIV-negative persons who use PrEP and receive a package of prevention, care and support services, the U.S. FDA approved combination anti-retroviral therapy (ART) for use as PrEP among sexually active adults at risk for HIV infection.

The New York State Department of Health, AIDS Institute has created a Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) modeled on and using the HIV Uninsured Care Programs (HUCP), primary care (ADAP Plus), operational systems and infrastructure. PrEP-AP will provide reimbursement for necessary primary care services for eligible individuals being seen by providers who are experienced providing services to HIV-negative, high-risk, individuals.

PrEP clinical guidelines call for the provision of regular HIV testing, counseling, sexually transmitted disease testing and treatment and supportive primary care services to assure that individuals receive the monitoring and care they need to continuously adhere to PrEP interventions and medication. While PrEP medication for the uninsured is covered by the manufacturer patient assistance program, the accompanying monitoring and care services are not.

Eligible providers will be reimbursed for a specific set of services including but not limited to HIV testing, counseling, sexually transmitted disease testing and supportive primary care services, consistent with clinical guidelines, http://www.hivguidelines.org. Enrolled providers will submit claims for covered services for eligible high-risk, HIV-negative individuals receiving PrEP, and the program will reimburse providers. Reimbursement is based on Medicaid primary care fee-for-service rates. Uninsured and underinsured individuals will be enrolled in the PrEP-AP program using the enrollment infrastructure and basic eligibility criteria of the HIV Uninsured Care Programs.

PrEP medication will be provided to uninsured individuals through the manufacturer patient assistance program (PAP). Providers are responsible for assisting patients with the PAP application to receive Truvada as indicated for PrEP. The HIV Uninsured Care Programs will staff a PrEP hotline to assist participants with the PAP process if problems or barriers are encountered and to refer participants to more comprehensive health care coverage when appropriate.

For information about participating in PrEP-AP, please call 1-800-542-2437.

The New York State Department of Health, AIDS Institute, Clinical Education Initiative provides a toll-free number for medical providers to discuss PrEP management with a specialist at 1-866-637-2342.

For general information about PrEP, call 1-800-541-AIDS or 1-800-233-7432 (Spanish)