MedicaidCoverageLow impact
Newsletter Vol. 26, No.16
New Jersey Medicaid·NJ · Infectious Disease, Family Medicine, Internal Medicine +1 more·Provider Notice
We identified it
Jun 20, 2026
Summary
The New Jersey Drug Utilization Review Board issued a provider notice regarding HIV Pre-Exposure Prophylaxis (PrEP) using Truvada (tenofovir/emtricitabine). This is an informational bulletin encouraging appropriate prescribing of PrEP for high-risk individuals, addressing documented under-utilization. The notice provides clinical guidance on patient eligibility, dosing, follow-up requirements, and monitoring protocols for providers in New Jersey.
Action Required
This is an informational/educational notice from the New Jersey Drug Utilization Review Board. No immediate billing workflow changes are required. Billing team should: (1) Retain this newsletter for reference; (2) Be aware that PrEP prescriptions may increase as providers educate themselves on appropriate use; (3) Ensure claims for Truvada (medication) and associated follow-up visit codes are processed correctly when submitted; (4) If questions arise about coverage or prior authorization requirements for PrEP in New Jersey state programs, contact the DURB at the address listed or review individual payer guidelines. This is educational guidance only and does not establish new billing requirements or coverage mandates.