Frequently Asked Ques�ons: - Accessing Pre-exposure Prophylaxis (PrEP) in Massachusets

These plans must cover prevenve services recommended by various groups of experts and government agencies, specifically:i 1) Items and services rated “A” or “B” by the United States Prevenve Services Task Force (USPSTF); 2) Immunizaons recommended by the Advisory Commitee on Immunizaon Pracces (ACIP) of the Centers for Disease Control and Prevenon (CDC); 3) Prevenve care and screenings for infants. [...] However, the Massachusets Fiscal Year 2024 Budget included provisions to require various state- regulated insurance plans to cover USPSTF-, ACIP-, and HRSA- recommended prevenve services (established by federal regulaon/guidance on or before July 1, 2023) at no addional cost to consumers.v The Massachusets Division of Insurance is expected to issue guidance about this requirement and future update. [...] A Massachusets law called the PATCH Act can help keep informaon about health services private by allowing members (including members under 18 years of age who are covered by the insurance plan of a parent or guardian) to request to send certain documents like Explanaon of Benefits (EOBs) or Summary of Payments (SOPs) to a different address or confidenal paent portal.xv An individual only needs to. [...] Helpful informaon includes the name of the insurance company, name of the relevant plan or plans, type of PrEP impacted, and prior authorizaon raonales submited. [...] “[If] a recommended prevenve service is medically appropriate for the individual – such as, for example, providing a mammogram or pap smear for a transgender man who has residual breast ssue or an intact cervix – and the individual otherwise sasfies the criteria in the relevant recommendaon or guideline as well as all other applicable coverage JANUARY 2024 | 4 about:blank about:blank about:blank a.