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PrEP User on United Healthcare? Here's How to Keep Your HIV Prevention Meds Despite Insurance Obstacles

June 13, 2017

United Healthcare's new prescribing requirements for Truvada (tenofovir/FTC) for pre-exposure prophylaxis (PrEP) begin on July 1. In the spirit of HIV prevention and health promotion, the National Coalition for LGBT Health has come up with guidelines to help United Healthcare-insured PrEP users stay safe this summer:

Ask for a vacation refill: If you have another refill available before the first of July, you can get a vacation refill. If you walk into the pharmacy where you usually pick up your PrEP and say you're going on vacation, they should give you enough medication to get by for another month. Just make sure you call your provider first and make sure you have enough refills. It isn't a permanent solution, but it should provide some room to jump the new hurdles United Healthcare (UHC) has put into place should they result in medication delays.

Switch to a 90-day prescription: If you are out of refills and won't get another before July 1, give your doctor a call and ask them to switch you from a 30-day prescription to a 90-day prescription, and ideally pick it up on June 29. That will give you an extra three months to navigate the new requirements.

Opt-out of their mail-order pharmacy: UHC wants you to use their pharmacy, BriovaRx. Along with prior authorization, UHC is requiring Truvada for PrEP to be filled through their mail-order pharmacy. If having your HIV prevention medication delivered by mail concerns you, you are not alone. We are currently researching whether BriovaRx and UHC will let you exercise an "opt-out option."

We encourage you to call and request the annual opt-out. To opt-out of the mail-order requirement, members can either download and submit a form or call 1-866-803-8570. Members asked to have available their membership number and the name and address of the in-network pharmacy they want to designate to obtain their PrEP medications. You will have to coordinate with United to find a local pharmacy that will fill the prescription.

Tell UHC that you are concerned about your privacy. UHC has been sued before over its ability to force people to use a specialty pharmacy. It was forced to provide an opt-out option.

To opt-out using the only the online form, go to the OptumRx website. When a UHC member goes to OptumRx site and logs in as a registered user, the member portal will authenticate that person as a UHC customer and offer the option to opt-out under the Specialty Pharmacy section.


OptumRx website


The link takes you to "Commonly Used Forms." The forms are toward the bottom of the page:


OptumRx Commonly Used Forms


The form autofills with the customer's information. Complete the form before July 1 to claim the specialty pharmacy exemption.

If you prefer to have your medication delivered to you, you need to register with UHC's specialty pharmacy BriovaRx ASAP or you will risk your next prescription being delayed. You can register online or by phone at 1-855-427-4682.

Finally, UHC's changes do not affect Gilead's Patient Assistance Program.

To check if you qualify for co-pay assistance, click [here https://www.gileadadvancingaccess.com/get-started-advancing-access].

Benjamin Brooks is the manager of the National Coalition for LGBT Health in Washington, D.C. He guides the Coalition's education and advocacy efforts to increase health equity for LGBT communities.


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