Reminder: Ambetter From Fidelis Care and Essential Plan – Pre-Exposure Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP) Cost-Share Waiver
2025/6/20
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Posted by Provider Relations
Fidelis Care would like to remind our providers of plan changes for Ambetter From Fidelis Care and Essential Plans in response to a recent NY Senate Bill addressing copayments for PrEP and PEP medications. The in-network cost share for members will be waived for medications used for PrEP and PEP, provided that an appropriate ICD-10 diagnosis code is documented on the prescription sent to the Pharmacy.
Below are updated lists of medications indicated for PrEP and/or PEP.
PrEP Medications:
- Descovy Tab 200-25 MG
- Apretude INJ 600 MG/3 ML
- Tuvada 200-300MG; Emtricitabine-tenofovir 200-300MG
PEP Medications:
- Tivicay Tab 50 MG
- Isentress Tab 400 MG
- Darunavir Tab 800 MG; Prezista Tab 800 MG
- Ritonavir Tab 100 MG
- Ritonavir Cap 100 MG
- Truvada 200-300MG; Emtricitabine-tenofovir 200-300MG
REMINDER: For cost sharing to be waived on Pharmacy Benefit claims, members’ PrEP and PEP prescriptions sent to their pharmacy of choice must include an ICD-10 diagnosis for PrEP or PEP.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.