Skip to Main Content

HIV Pre-exposure Prophylaxis (PrEP) Education and Resources

Date: 10/22/2024
LOB: Medicaid
Audience: Meridian Medicaid Providers

Meridian Health Plan of Michigan would like to communicate information related to considering patients under your care for use of Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis (PrEP) medication, patient counseling, and prescription talking points.  

More than 30,000 new HIV infections occur annually in the United States. In Michigan, for the year 2023, there were 696 newly diagnosed HIV cases, and 18,437 persons living with HIV. Because there are currently no vaccines to prevent the transmission of HIV between individuals, a combination of behavioral and medical methods are used for preventing new infections when necessary. 

Assessment of an individual’s risk of acquiring new HIV infection and the decision to initiate PrEP medication can be uncomfortable topics for discussion between patients and providers. It is the recommendation of the United States Centers for Disease Control and Prevention (CDC) that all sexually active patients should be informed about HIV PrEP.  

However, the decision to initiate PrEP therapy primarily depends on the individual’s risk for acquiring HIV infection, with variable risks of new infection based on the types of potential exposure including blood-borne exposure (such as needle-sharing with injection drug use) or sexual exposure (history of previous sexually transmitted infections, persons engaging in unprotected sexual intercourse with multiple partners, persons engaging in sexual intercourse with persons that have a detectable infection).  

The CDC recommends the following persons who are HIV-negative should consider PrEP: 

  • You have a sexual partner with HIV (especially if the partner has unknown or detected viral load)
  • You have not consistently used a condom 
  • You have been diagnosed with a sexually transmitted infection in the past 6 months 
  • You are a current injection drug user and have an injection drug use partner with HIV 
  • You are a current injection drug user and share needles, syringes, or other equipment to inject 
  • You have a non-occupational risk hazard (such as sexual behavior or injection drug use) and you have been prescribed post-exposure HIV prophylaxis (PEP) and used multiple courses of PEP 

Discussion of these topics and helping guide a patient to the decision to initiate PrEP can be especially difficult for some patients who are members of the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other identities (pansexual, agender, non-binary, gender fluid), commonly represented as “LGBTQIA+” who may not actively seek needed care or voice concerns about HIV prevention with their provider, often fearing personal judgement or stigma.  

Patients who are interested in PrEP should be counseled that this type of preventative therapy is safe and highly effective when medications are taken as prescribed and the patient remains adherent. Multiple published studies on PrEP effectiveness show that consistent use of PrEP reduces the risk of new HIV infection from sex by about 99%, and from injection drug use by at least 74%. 

There are three Food and Drug Administration (FDA) approved medications for use as PrEP. Two oral medications Truvada (and its generic formulations), Descovy, and a long-acting injectable medication Apretude. The State of Michigan Fee-for-service Medicaid program pharmacy benefit administered by Prime Therapeutics (formerly known as MagellanRx) covers each without a prior authorization. These drugs are considered “carve-outs” and not covered under a members medicaid Managed Care Plan. 

Medication Name 

Brand name (Generic name)

Dosage Frequency 
Coverage & Other Notes 

Truvada and generic 

(emtricitabine-tenofovir disoproxil fumarate) 

One tablet of 200mg-300mg (co-formulated tablet contains both ingredients) Once dailyNo prior authorization required. Covered by Fee-for-service Michigan Medicaid. 

Descovy 

(emtricitabine-tenofovir alafenamide) 

One tablet of 200mg-25mg (co-formulated tablet contains both ingredients) Once daily No prior authorization required. Covered by Fee-for-service Michigan Medicaid. 
Apretude  (Cabotegravir)Intramuscular injection of 600mg once every 4 weeks for 2 starter doses, followed by 600mg once every 2 months starting 2 months after the last starter dose Starter dose (every 4 weeks for 2 doses) then every 2 months 

No prior authorization required. Covered by Fee-for-service Michigan Medicaid. 

Continuation injections may be administered up to 7 days before or after the date the individual is scheduled to receive the injection. 

 

Fee-for-service Michigan Medicaid Important Contact Information 

  • Prime Therapeutics (formerly known as MagellanRx) 
  • Weblink: https://mi.primetherapeutics.com/contact
  • Beneficiary Help Line : 1-800-642-3195 
  • Pharmacy Help Line : 1-877-624-5204 
  • Provider Relations Line: 1-888-868-9219 

Once the decision has been made to start PrEP, patients should be evaluated for any potential drug to drug interactions, and for counseled for common side effects including nausea, diarrhea, headache, dizziness, and insomnia. These common side effects generally decrease over time; however, patients should report any bothersome side effects or other concerns to their prescriber.  

After starting PrEP, patients should always be encouraged to remain adherent to taking medication daily (for oral tablet regimens) or to their injection schedule (if using injectable regimen). Patients should be encouraged to continue safe sex practices and/or clean injection equipment for injection drug users. Patients should be counseled that PrEP does not protect against non-HIV sexually transmitted infections (STIs), and that continued use of condoms is important to reduce the risk of contracting STIs. 

After starting PrEP, regular follow-up with remains essential for the patient, usually with an HIV test every 3 months to confirm negative status. It is also important to counsel that if a patient becomes HIV positive, they will need to switch to an appropriate therapy for treatment and suppression of active HIV infection.  

 

Provider resources for HIV PrEP 

Last Updated: 10/18/2024