HIV PEP and PrEP Agents

HIV PEP and PrEP Agents – Combivir (lamivudine-zidovudine), Descovy (emtricitabine-tenofovir af), Epivir (lamivudine), Isentress (raltegravir potassium), Kaletra (lopinavir-ritonavir), Retrovir (zidovudine), Tivicay (dolutegravir sodium), Truvada (emtricitabine-tenofovir df), Viread (tenofovir disoproxil fumarate)

Self-Administration – Oral

Diagnosis considered for coverage:

• HIV-1 pre-exposure prophylaxis (PrEP)
• HIV-1 post-exposure prophylaxis (PEP)

Coverage Criteria:

WHA covers antiretroviral medications at $0 cost share when the following conditions are met:

• The medication being prescribed is one of the following:
  • emtricitabine-tenofovir df (generic Truvada)
  • Descovy
  • tenofovir disoproxil fumarate (generic Viread)
  • Isentress
  • Tivicay
  • lamivudine-zidovudine (generic Combivir)
  • lamivudine (generic Epivir)
  • zidovudine (generic Retrovir)
  • lopinavir-ritonavir (generic Kaletra), AND
• The medication is being used for HIV-1 pre-exposure prophylaxis (PrEP) or HIV-1 post-exposure prophylaxis (PEP)

Coverage Duration:

• Initial: 1 year

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria for $0 cost share established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information:

• There are two pills approved for use as PrEP: Truvada and Descovy. Truvada is for people at risk through sex or injection drug use. Descovy is for people at risk through sex. Descovy is not for people assigned female at birth who are at risk for HIV through receptive vaginal sex.
• Apretude is the only shot approved for use as PrEP. Apretude is for people at risk through sex who weigh at least 77 pounds (35 kg).
• PrEP is very effective when taken consistently. It reduces the risk of HIV from sex by ~99%. In patients who inject drugs, it reduces the risk of HIV by at least 74%.
• An HIV test must be taken every 3 months while taking PrEP.
• PEP Must Be Started Within 72 Hours of Possible Exposure to HIV.

Policy Updates:

• 11/14/2023 – New policy approved by P&T.

References:

1. Truvada Prescribing Information. Gilead Sciences, Inc. Foster City, CA. June 2020.
2. Descovy Prescribing Information. Gilead Sciences, Inc. Foster City, CA. January 2022.
3. Viread Prescribing Information. Gilead Sciences, Inc. Foster City, CA. April 2019.
4. Isentress Prescribing Information. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. July 2017.
5. Tivicay Prescribing Information. GlaxoSmithKline. Durham, NC. October 2022.
6. Combivir Prescribing Information. GlaxoSmithKline. Research Triangle Park, NC. May 2019.
7. Epivir Prescribing Information. Research Triangle Park, NC. November 2020.
8. Retrovir Prescribing Information. ViiV Healthcare. Durham, NC. June 2023.
9. Kaletra Prescribing Information. AbbVie Inc. North Chicago, IL. April 2023.