MedicaidCoverageMedium impact
MMP 25-44: Removal of Pharmacy Copayment for Drugs Used to Prevent Human Immunodeficiency Virus (HIV) (Pre-Exposure Prophylaxis [PrEP] & Post-Exposure Prophylaxis [PEP])
Michigan Medicaid - MDHHS·MI · Infectious Disease, Family Medicine, Internal Medicine +1 more·Pharmacy
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Effective November 1, 2025, Michigan Medicaid, Healthy Michigan Plan, and MOMS programs will eliminate pharmacy copayments for HIV prevention drugs (PrEP and PEP). Billing teams should verify these drugs are marked as 'No' copay on the Michigan Pharmaceutical Products List to ensure proper billing.
Action Required
Before November 1, 2025: Billing team must verify HIV PrEP and PEP medications show 'No' under the 'Copay' column on the Michigan Pharmaceutical Products List at https://mi.primetherapeutics.com/. Update billing system to reflect $0 copay for these drugs for Michigan Medicaid beneficiaries. Monitor for State Plan Amendment approval from CMS as implementation is contingent on this approval.