MedicaidCoverageMedium impact
Carve In of the HIV/AIDS Medicatiions Effective January 1, 2020
Maryland Medicaid·MD · Infectious Disease, Internal Medicine, Family Medicine +1 more·Provider Transmittal
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Maryland Medicaid is implementing a carve-in of HIV/AIDS medications effective January 1, 2020, meaning these medications will now be covered under the medical benefit rather than through a separate pharmacy benefit manager. This affects how HIV/AIDS medication claims should be processed and billed for Maryland Medicaid patients.
Action Required
Effective January 1, 2020: Billing team must update procedures for HIV/AIDS medication claims for Maryland Medicaid patients. Verify that HIV/AIDS medications are now billed through the medical benefit rather than pharmacy benefit. Contact Maryland Medicaid for specific billing guidelines and update internal protocols accordingly.