Emblem Health to Cover PrEP Medications

Here is some good news about a change to Welfare Fund and Emblem Health drug coverage.

Effective July 1^st, 2020, the GHI-CBP and HIP HMO plans will cover the cost of health care services and medicines for the detection and prevention of HIV, including screenings and pre-exposure prophylaxis (PrEP). This means there will be no cost-sharing, including copays, coinsurance or deductibles for HIV prophylaxis (PrEP) medications.

As of July 1, PrEP medications will be available, free of charge, when members present their GHI-CBP or HIP HMO card along with a doctor’s prescription at the pharmacy.  They will no longer be able to use the Welfare Fund CVS Caremark card for PrEP medications.

We understand that the switch in coverage for these prescriptions may be cause for confusion, at first, but we believe the savings members will experience will outweigh any initial inconvenience.

IMPORTANT NOTE

If members are unable to derive results from Truvada, their provider can request Descovy on an exception-basis only. Providers will need to call 1-833-269-4653 for HIP members and 877-534-3682 for GHI members.

If members have been denied, they can appeal using one of the following methods:

By Phone:
1-877-793-6253

In writing by mail:
EmblemHealth
Grievance and Appeals Unit
PO Box 2844
New York, NY 10116-2844

By fax:
EmblemHealth
Grievance and Appeals
Unit
1-212-510-5320