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New coverage for IVF and HIV prevention

Effective July 1, 2020, the CBP/GHI plan and the HIP HMO plan will make two important changes:

  1. Expanded coverage of in-vitro fertilization
  2. Addition of coverage for HIV prevention prescription drugs

Expanded IVF coverage

Coverage will be expanded to include certain oral in-vitro fertilization (IVF) prescription drugs as well as access to fertility preservation services. These services include sperm storage in connection with IVF, and cryopreservation services and storage of embryos in connection with IVF. Emblem Health will also cover oral drugs in connection with IVF, specifically, Clomiphene Citrate and Serophene. IVF services will continue to be subject to deductibles and co-pays, where applicable.

Injectable drugs to support IVF will remain covered under the PICA program.

Preauthorization for all infertility related services continues to be required.

Surrogacy services continue to be excluded from the Plans.

HIV prevention

The full cost of health care services and medicines for the detection and prevention of HIV will be covered, including screenings and pre-exposure prophylaxis (PrEP). PrEP is a way to prevent HIV infection by taking a pill every day.

In most cases, the Plan will approve Truvada as the PrEP treatment. If Truvada is not appropriate for a particular patient, alternative treatments will be considered on a case by case basis with medical documentation.

If you have questions, call the Customer Service number on your member ID card. A representative will be happy to help.

Related Topics: Health Benefits