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Division of Insurance releases HIV medication coverage guide

December 1 is World AIDS Day
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Today, December 1, is World AIDS Day. This annual, global event provides a platform to raise awareness about HIV/AIDS, eliminate HIV-related stigma, and honor the lives affected by the epidemic. In the spirit of this event, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has created a guide on insurance coverage of prescription medications to prevent and treat HIV, a virus that attacks the body's immune system that can lead to AIDS if left untreated.

2024 Colorado Division of Insurance HIV Prevention and Treatment Coverage Guide 

The tables in the guide summarize medication coverage for each health insurance company offering individual plans (meaning coverage not through an employer) and small group plans (for small employers with less than 100 employees) for 2024. It can be used to review the coverage and drug lists of HIV prevention and treatment medications by each insurance company. These tables do not review each plan from the insurance companies, nor all formularies offered by each company, so it is important for consumers to review plans to confirm coverage. The guide lists medications individually by treatment category, as well as by the most commonly prescribed medications by providers for consumers, as specified by the Food and Drug Administration (FDA). 

As we are in the midst of the annual open enrollment for individual coverage (for people who don’t get insurance from an employer), this coverage guide can also help in choosing a health insurance plan for 2024. It also includes information about Colorado coverage requirements, including cost, access to medication by a provider or pharmacist, and other non-discrimination protections. 

As the drug Pre-Exposure Prophylaxis (PrEP) is covered as a preventive treatment under the ACA, health insurance companies must also cover the required PrEP baseline and monitoring services without copayment or other cost-sharing. These services may include testing, screenings, and counseling. 

Find more information at our website LGBTQ Health Care Rights and Resources

People with questions about their health insurance coverage can contact the Division of Insurance Consumer Services Team: 303-894-7490 / [email protected] / (click on “File a Complaint”).