Post-exposure prophylaxis, or PEP, is the commonly used term for a drug regime taken within 72 hours after a possible exposure to human immunodeficiency virus (HIV) to prevent HIV infection. The Centers for Disease Control and Prevention (CDC) has developed guidelines for the administration of PEP, which includes prescribing a 28-day course of treatment after a patient reports exposure to bodily fluids, the source of which is known to be HIV positive, within the last 72 hours and that exposure presents a substantial risk for transmission. A case-by-case determination is recommended when the HIV infection status of the source of the body fluids is unknown and the circumstances of the reported exposure presents a substantial risk for transmission.
Hospitals must adopt a policy, consistent with CDC guidelines, for the dispensing of PEP. This policy must ensure that hospital staff dispense to a patient, with a patient's informed consent, at least a 5-day supply of PEP drugs or therapies following the patient's possible exposure to HIV, unless medically contraindicated.
Once each calendar year, the Department of Health must provide to each critical access hospital in the state, at no cost to the hospital, one 30-day supply of PEP drugs or therapies, unless refused for reason of conscience or religion.
Beginning in 2025, a health carrier may not impose cost sharing or require prior authorization on any PEP drugs. For health plans with a health savings account (HSA) the carrier must set the cost-sharing amount at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions and withdrawals from the HSA.