Frequently Asked Questions: - Accessing Pre-exposure Prophylaxis (PrEP) in Massachusetts

These plans must cover preventive services recommended by various groups of experts and government agencies, specifically:i 1) Items and services rated “A” or “B” by the United States Preventive Services Task Force (USPSTF); 2) Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC); 3) Preventive care and screeni. [...] However, the Massachusetts Fiscal Year 2024 Budget included provisions to require various state- regulated insurance plans to cover USPSTF-, ACIP-, and HRSA- recommended preventive services (established by federal regulation/guidance on or before July 1, 2023) at no additional cost to consumers.v The Massachusetts Division of Insurance is expected to issue guidance about this requirement and futur. [...] A Massachusetts law called the PATCH Act can help keep information 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 Explanation of Benefits (EOBs) or Summary of Payments (SOPs) to a different address or confidential patient portal.xvii An individual onl. [...] Helpful information includes the name of the insurance company, name of the relevant plan or plans, type of PrEP impacted, and prior authorization rationales submitted. [...] “[If] a recommended preventive 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 tissue or an intact cervix – and the individual otherwise satisfies the criteria in the relevant recommendation or guideline as well as all other applicable coverage requirements, the plan or issuer must provide.