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HIV Drug Treatment Policy Clarification

May 3, 2017

In order to prevent unnecessary delays in treatment, the Department of Health Care Services (DHCS) wishes to clarify the use of the word “treatment.”  When used to describe the Code I restriction on agents used to treat Human Immunodeficiency Virus (HIV), the use of the word “treatment” refers to individuals with a positive HIV test as well as those prescribed the medication for post-exposure prophylaxis (PEP) of HIV.

For information about HIV prescription covered products and program coverage, refer to the Drugs: Contract Drugs List Part 1 section of the Medi-Cal Pharmacy provider manual.

For an explanation of Code I restriction language, providers should refer to the Drugs: Contract Drugs List Introduction section of the Medi-Cal Pharmacy provider manual.