HIV Advocates Disagree Over CMS Decision To Nix Prior Auth For PrEP

New guidance from CMS on coverage of pre-exposure prophylaxis (PrEP) for HIV/AIDS is dividing patient advocates, spotlighting the debate over utilization management techniques and CMS’ enforcement of requirements for insurers. CMS has clarified that private insurers must cover long-acting injectable PrEP, along with other PrEP options. While some advocates cheer on the agency for eliminating step therapy and prior authorization, others think the new requirement, which doesn’t allow for plans to incentivize the use of lower-priced generic options, will lead...