News Release

New Jersey Department of
Banking and Insurance

Commissioner Justin Zimmerman

For Immediate Release:
January 8, 2025

For Further Information:
Dawn Thomas - E-mail
Nancy Kearney - E-mail
(609) 292-5064

TRENTON — In a bulletin issued today, the New Jersey Department of Banking and Insurance reminds insurers that the federal Affordable Care Act (ACA) requires coverage for HIV pre-exposure prophylaxis (PrEP), including long-acting injectable forms of the medication, be provided for free to consumers at increased risk of contracting HIV.

The ACA’s prohibition against imposing out-of-pocket costs to consumers dates to 2019 when the United States Preventive Services Task Force recommended that clinicians offer PrEP with “effective antiretroviral therapy to persons who are at high risk of HIV acquisition.” In 2023, the Task Force recommended additional formulations of PrEP including an additional daily oral pill and the first long-acting injectable PrEP medication.

Accordingly, carriers must cover specified oral and injectable formulations of PrEP and cannot use medical management techniques to direct individuals prescribed PrEP to use one of the specified formulations over another.

“This guidance reminds carriers of their responsibility to provide access to this effective medication with no out-of-pocket costs and ensures that consumers can use the form of PrEP that meets their needs," said Commissioner Justin Zimmerman. “As the new plan year begins, it is important for consumers to be aware of the benefits covered so they can access medication and use the services needed to take care of their health.”

Tests, physician visits and other services related to PrEP and included in PrEP billing should also be covered with no out-of-pocket costs to consumers. For example, other covered services include: HIV testing, Hepatitis B and C testing, pregnancy testing, sexually transmitted infection screening and counseling and counseling to assess behavior and adherence to ensure that PrEP is used as prescribed and to maximize PrEP’s effectiveness.

If a consumer is encountering an issue with PrEP coverage, the department encourages them to report their concern. The department may be reached through our consumer hotline at 1-800-446-7467 (8:30 am to 5:00 pm EST Monday-Friday), or by visiting the department’s website and clicking on Consumer Assistance - Inquiries/Complaints, at www.state.nj.us/dobi/consumer.htm.

Eligible residents without health insurance can find coverage through Get Covered New Jersey, the state’s Official Health Insurance Marketplace. Nine in 10 consumers enrolling in coverage through Get Covered New Jersey receive financial help and many can find a plan for $10 a month or less. Open Enrollment runs through January 31, 2025. More information may be found at GetCovered.NJ.gov.