Michigan's Weird Relationship with PrEP

The state of Michigan Department of Community Health has a strange relationship with PrEP (Pre-Exposure Prophylaxis). 

Back in December, officials at MDCH told me that PrEP was an "exciting possibility for the future." Officials then said the agency was discussing internally the findings and the science. But they said then, there would be no guidance in the near term. 

So, fast forward to last week, when MDCH officials confirmed that Medicaid, the state's low income insurance program, would pay for Truvada prescriptions assigned to patients at risk. 

"HIV drug therapies are covered, without prior authorization, as a Fee-For-Service pharmacy benefit for both Fee-For-Service and Health Plan enrolled Medicaid beneficiaries," MDCH spokesperson Angela Minicuci told me for my report in Michigan's LGBT newspaper Between the Lines. "Coverage is unrestrictd and available when a medical practioner evaluates the Medicaid's beneficiary and determines a prescription for HIV drug therapy is medically necessary. Ultimately, HIV drug therapy is covered whether the particular prescription is to treat a Medicaid beneficiary with HIV diagnosis or for exposure prophylaxis, etc."

Great news, right? Not so fast there folks. Minicuci then said the state had no plans to issue guidance related to PrEP prescriptions. 

This is not the first time the department has dropped the ball on an important approved prevention intervention. In 2010, an investigation by Michigan Messenger found that access to non-occupation post-exposure prophylaxis was entirely dependent on where a person lived in the state. MDCH had no official policy on n-PEP, and it took them 18 months to develop and distribute one. 

So when the CDC blasted out its new clinical PrEP guidance Wednesday, I was eager to see what MDCH had to say. Yeah, well, I am still waiting for Minicuci to respond to emails and phone calls seeking comment from the agency on how it will address PrEP now that the feds have a comprehensive clinical plan in place.

And as I noted in my story on Medicaid access to PrEP, a state guidance is important to state health care providers. Stevi Atkins, executive director of AIDS Wellness in Flint, says PrEP is not on anyone's radar but her agency's. A guidance and message from the state heatlh department would dramatically change the radar calculus in Michigan.  

UPDATE: Literally minutes after I wrote this, Angela Minicuci, the spokesperson for MDCH emailed me. 

PrEP is an important ool in the prevention of HIV and the CDC guidance in support of PrEP is a major step forward," she wrote. "MDCH will follow the CDC guidance on PrEP and the prevention and treatment of HIV. As we are still reviewing the recommendation, we will be determining how this information will be distributed."