HIV Medications, Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP)

Please pay close attention to the following as there are CRITICAL differences in how HIV/AIDS medications and medications for PEP (post-exposure prophylaxis) and PreP (pre-exposure prophylaxis) are covered in the District of Columbia. 

HEALTHY FAMILIES BENEFICIARIES: HIV/AIDS medications, PEP, and PreP for Healthy Families beneficiaries are covered through the District of Columbia Fee-for-Service only and are not the responsibility of MedStar Family Choice. 

ALLIANCE BENEFICIARIES: For Alliance beneficiaries, medications for the treatment of HIV/AIDS are supplied through the AIDS Drug Assistance Program (ADAP). All members must apply to the ADAP program and renew every 6 months. Prescriptions for HIV and AIDS medications must be filled at ADAP-participating pharmacies. Prescriptions for PEP and PreP may be filled at any MedStar Family Choice in-network pharmacy. PLEASE note ON THE PRESCRIPTION that the intended use of the medication is for PEP or PrEP as this will assist the pharmacy in processing the prescription expeditiously. For example, include the phrase, “for PrEP” anywhere on the prescription.

 

HEALTHY FAMILIES MEMBERS

ALLIANCE MEMBERS

Beneficiary has HIV/AIDS

Process through District of Columbia Fee-for-Service

Beneficiary must use ADAP Pharmacy*

Beneficiary needs PEP or PrEP

Process through District of Columbia Fee-for-Service

Any MedStar Family Choice in-network pharmacy

*MEDICATIONS SUPPLIED THROUGH ADAP PHARMACIES (ADAP FORMULARY)-https://dchealth.dc.gov/sites/default/files/dc/sites/doh/service_content/attachments/ADAP%20Formulary%20July%202020.pdf

*LIST OF ADAP-PARTICIPATING PHARMACIES
https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/HIV%20AIDS%20Pharmacy%20Provider%20Network%20%20%28%20Feb%202020%29.pdf

 

Information current as of: 04/12/21