The HIV+Hepatitis Policy Institute had accused Blue Cross & Blue Shield of Mississippi of violating federal preventive health coverage requirements with its HIV offerings. The insurer has since updated its formulary to include two of the drugs in question.
Mississippi Today reported June 17 that the insurer said it updated its formulary to explicitly encompass Descovy and Apretude. The insurer also told the outlet that providers were previously able to request coverage through an exceptions protocol.
On June 1, the advocacy group sent a letter to the state’s insurance commissioner to lodge a formal complaint, claiming the insurer did not cover “newer” pre-exposure prophylaxis medications to prevent HIV, instead focusing on generic Truvada.
In 2023, the U.S. Preventive Services Task Force recommended that “plans and issuers must cover, without cost-sharing, the three FDA-approved PrEP formulations (two oral and one injectable) and are not permitted to use medical management techniques to direct individuals prescribed PrEP to utilize one formulation over another,” according to a 2024 federal document. At the time, the oral drugs Truvada and Descovy, as well as the injectable Apretude, had already secured FDA approval.
The complaint also said the company’s medical policy deprioritizes long-acting injectables for HIV. The injectable Yeztugo is the most recently approved PrEP formulation, which BCBS Mississippi also does not cover, the letter said.
A BCBS Mississippi public formulary portal clarified that “the presence or absence of a medication in this list does not indicate whether it is a covered benefit.” Coverage for Apretude, for example, is listed under a separate medical prescription portal. That portal listed Yeztugo, as well as the Cabenuva injectable for HIV treatment, as “not covered.”
“Most insurers have added Yeztugo coverage, demonstrating their understanding that preventive coverage mandates encompass all FDA-approved PrEP drugs,” the complaint said.
On June 12, BCBS Mississippi told Becker’s it covers PrEP medications for fully insured members with no cost-sharing, including the generic equivalent for Truvada, Descovy and Apretude. BCBS Mississippi’s website said it updated PrEP guidelines June 11, after that letter was sent.
“BCBSMS also collaborates with network providers to identify the most appropriate PrEP medications for each patient, regardless of whether the drug is listed on the formulary,” the insurer said, adding that its formulary has roughly 20 HIV treatment options.
“If clinical circumstances of a member are not met with the treatment options on the formulary, an exception process is in place to work with the network provider to address the clinical needs of the member,” the statement continued.
In a June 15 news release, HIV+Hepatitis Policy Institute Executive Director Carl Schmid said the team is “pleased that Blue Cross Blue Shield of Mississippi has taken steps to comply with federal preventive coverage requirements by adding these two PrEP drugs.”
“But by excluding other long-acting medications, which are recommended in national HIV treatment and prevention guidelines, Mississippians are still not able to access these highly effective drugs that improve patient adherence,” he continued.
Editor’s note: This story was updated June 17 to clarify the timeline of changes.
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