UC San Diego Health System La Jolla. New pt# (800) Existing pt # (858) New pt#: (800) Existing Pt#: (619)

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1 The purpose of this list is to offer guidance for getting a prescription for Truvada as pre-exposure prophylaxis (PrEP). It does not guarantee coverage. Verify that your insurance is accepted BEFORE SCHEDULING AN APPOINTMENT with a doctor. You can do this by contacting the scheduling/registration line at the clinic you wish to attend OR your insurance company. Either can provide more detailed information about your insurance coverage and costs associated with being on PrEP ($). This list is made available by the UC San Diego AntiViral Research Center and California HIV/AIDS Research Program and is current, as of February Physician Name Medical Group Contact Info Insurance Taken Dr. Sheldon Morris 9333 Genesee Avenue Suite 200 La Jolla, CA Dr. Kenneth J. Griffiths 4th & Lewis Medical Offices 330 Lewis Street La Jolla - Hillcrest New pt# Existing pt # (858) New pt#: Existing Pt#: (619) Primary Care Provider Medi-Cal FFS Care 1st Medi-Cal HMO (Primary and specialty; Primary for HIV patients only) Community Health Group (CHG) Medi-Cal HMO (Specialty)* Community Health Group (CHG) Medicare/Medi-Cal (Dual eligible) HMO (Specialty)*-As of 7/15/14, UC San Diego is no longer able to accept CHG insurance for firsttime primary care appointments. Health Net As of 1/1/15, UC San Diego is no longer able to accept Health Net Medi-Cal, but may accept specialty care referrals when authorized by Health Net.Molina Medi-Cal Molina Medicare/Medi-Cal (Dual eligible)

2 Dr. Aimee Lopes 2020 Genesee Ave, San Diego, CA Dr. Steve Gardner 2020 Genesee Ave San Diego, CA Dr. Miguel Goicoechea N Torrey Pines Rd La Jolla, CA Dr. Shawn Harrity 4910 Directors Place San Diego, CA Sorrento Valley PCP will refer patient to Infectious Disease provider Dr. Adam Zweig th Ave., Suite San Ysidro Health Center Southeast: King Chavez Health Center, 950. S Euclid Avenue, San Diego Mon. Fri. 8:00 AM to 5 PM San Ysidro: San Ysidro Health Center, 4004 Beyer Boulevard San Ysidro, CA Mon. Fri. 8:00 AM to 7:30 PM Saturday 8:30 AM to 2:00 Sharp Rees-Stealy Medical (858) Primary Care Provider Sharp patients ONLY (858) Scripps Clinic Torrey Pines (858) Specialist-ID Dept Sorrento Valley VA Medical Center AIDS Healthcare Foundation New pt # Existing pt # (619) La Jolla Village Dr. San Diego, CA Tuesdays and Thursdays, 8:30am 5:30pm (Closed for lunch 12:20-1:20) Wednesday 11am-3pm General Line:(619) Bill Grimes 8-5pm Bill s direct line:(619) (Accepts Medi-Cal s Molina and Community Health Group) MORE PROVIDERS LISTED ON NEXT PAGE Aetna, Anthem Blue Cross, Beech Street, Blue Shield, Champus Tricare, ChoiceCare/Humana, CIGNA, Coventry Healthcare, Covered CA, Health Net, Medicare/Medi- Cal, MultiPlan, Pacific Foundation for Medical Care, Sharp Health Plan, United Healthcare, VEBA Aetna (Commercial HMO)(EPO)(POS) (PPO) Arizona Foundation for Medical Care (Scripps Clinic only),beech Street PPO Network (also known as Concentra, CappCare, PPONext), Anthem Blue Cross HMO (also known as California Care HMO) Anthem Blue Cross (POS) (PPO) Anthem Blue Cross Prudent Buyer Blue Shield (HMO) Blue Shield of California (PPO),(POS)CHAMPUS TriCare Extra (PPO),for Life, Prime (HMO), Standard (Indemnity), Choice Care Network (PPO) Cigna (EPO)(HMO)(POS)(PPO), Coventry (HMO)(PPO), First Health (PPO), First Health/CCN (PPO)Health Net (Commercial HMO) (POS)Health Net Medicare (PPO) (Scripps Clinic only) Health Net Seniority Plus (Medicare HMO) Humana Choice Care Network(PPO) Medicare Assignment, MultiPlan (PPO) UnitedHealthcare (Commercial HMO)(PPO)Choice (POS) Private Healthcare Systems (PHCS) San Diego County Schools Fringe Benefit Consortium SCAN Health Plan (MedicareHMO) Scripps Employee Medical Plans (EPO/PPO) Secure Horizons (Medicare HMO)United HealthCare (HMO/PPO/EPO/NPP/POS) No CommunityHealthGroup, Molina, Care1st, Healthnet Medi- Cal Medicare and Medi-Cal, Private insurance and Covered California HMO/PPO Sliding scale availabie for uninsured- ID, proof of income and application required. Medi- Cal, Medicare as well as other insurances are accepted. Verify insurance is accepted when contacting the clinic s scheduling line.

3 Physician Name Medical Group Contact Info Insurance Taken Dr. Amy Sitapati 8939 Villa La Jolla Drive Suite 110 La Jolla, CA Dr. Maile Karris 4168 Front Street 3 rd Floor Suite 2A Dr. Robert Houghton st Avenue Ste 200B San Diego, CA Dr. Joseph Caperna st Avenue Ste 200B San Diego, CA Dr. David Shamblaw th Ave, San Diego, CA (619) Dr. Gary Woodall Tuesday/Thursday Night FHC th Street San Diego, CA (619) Dr. Mike Schmerber 9009 Mira Mesa Blvd., Ste 200 San Diego, CA Dr. Loretta Stenzel North County, SD UCSD Student Health Services 9500 Gilman Drive La Jolla, CA (University Center Bldg. 999) - La Jolla UC San Diego Health System- Hillcrest (Medical Offices South) (858) Internal Medicine *May be willing to approve override for PrEP patients* ID (619) Tues AM Dr. Karris specialist Private (619) PPO-Anthem Blue-Cross, Blue- Shield, Cigna, Humana, Health- Net, Unitedhealthcare; Will not accept Medicare or Medi- Cal. Will accept medi-medi Private (619) PPO- Anthem Blue-Cross, Blue- Shield, Cigna, Humana, Health- Net; will not accept Medicare or Medi-Cal Will accept medi-medi La Playa Medical (619) Most PPOs and Medicare No HMO, covered California or Medi-Cal Woodall only-mercy Medical HMO, Covered California s Blue Shield HMO UC San Diego Scripps Ranch *3 rd year resident* Vista Community Clinic UCSD Student Health Services Request PrEP appointment: Appts 5:30-7 Tu/Th Insurance help: Stan Lesky x4708 (858) PrEP case managers can help answer general PrEP questions;cost/insurance/etc Hunt Group #: ext Starting PrEP Vista: Sergio #: ext Sergio cell: ) Attendance to PrEP 101 class(es) required 2) Lab Work 3) Review of labs with PMD & then able to obtain prescription Appointment: (858) Main Line: (858) Medi-Cal s: Molina Community Health Group Care1st Medi-Cal and Medi-Cal Managed Care Medicare, Medicare Advantage, andmedicare Managed Care CMS: County Medical Service Covered California exchange plans through Anthem Blue Cross, Blue Shield, Health Net and Molina AIM Blue Cross EPO Blue Shield Tri-Care for military dependents and retirees Community Health Group Greater Tri-Cities Independent Practice Association (IPA) Molina Care 1st Workers Compensation Private Insurances (although we are an out-of-network provider for many HMO and PPO insurances) UC SHIP Kaiser Permanente Call Schedule initial appointment with PCP -PCP conducts initial screening and refers appropriate PrEP candidates to the Infectious Disease Division -Patient is seen by RNP, Rachel Toman, RN, Vince and HIV/ID pharmacist (Leia or Andy) -If RNP is on vacation, pt is seen by one of the following ID MD's (Vi Bowman, Robert Huang, Dale Lieu, Christopher O Brien, or Soniya Gandhi)

4 GETTING INSURANCE Are you uninsured? Do you wish to change your current CoveredCA plan? Open enrollment for 2015 health insurance plans ended on February 15, Special Enrollment has been extended until April 30, 2015 for consumers who did not realize there was a tax penalty in Otherwise, enrollment in or changes to Covered CA plans can only be made due to a qualifying life event. Visit to start investigating your options. Would you like support in choosing a plan that works for you? Certified Enrollment Workers are available at several locations throughout California. To find a Certified Enrollment Worker near you, visit scroll to the bottom of this webpage, and click on Find an Enrollment Counselor to find a counselor closest to you. Examples of local enrollment sites are listed below: San Diego LGBT Community Center Family Health Centers of San Diego: 3909 Centre Street, San Diego, CA, Enrollment support available at all FHCSD locations , ext. 213 (Sarah) bbarnes@thecentersd.org San Ysidro Health Center 678 3rd Avenue, Chula Vista, CA, ACAinfo@syhc.org You can apply for Medi-Cal at any time if your annual income is less than 15,900/year! Medi-Cal covers PrEP! If you have Medi-Cal, make sure your pharmacist bills the state directly and NOT your Medi-Cal MCO (Managed Care Organization), as PrEP is considered a Carved Out medication. If your employer-based insurance plan does not cover PrEP, explore whether you have alternative plan options during open enrollment. Contact your HR department to find out when open enrollment occurs for your organization. If there is no alternative option within your organization, you can switch to a CoveredCA plan but there are many items to consider first: See enclosed information regarding prior authorizations. PAYING FOR PREP If your insurance offers some coverage but you have a co-pay: Gilead Co-Pay Coupon Card - or call Intended for those with insurance but with high co-pays. Can be used for up to 12 co-pays within 12 months for the length of enrollment. Card is not valid for prescriptions eligible to be reimbursed in whole or part, by Medicare, Medicaid, any other federal or state-funded healthcare benefit program, by private plans, or other health or pharmacy benefit programs, which reimburse you for the entire cost of your prescriptions drugs. Program currently scheduled to expire December 31, 2015; may be extended.

5 If your monthly, out-of-pocket cost is being quoted at approximately $1400/month for PrEP: This may mean that you have not met your deductible, your insurance company does not cover PrEP, or that prior authorization is required. What is a deductible? o The amount you pay for health care services before your health insurance begins to pay. What is prior authorization? o Prior authorization means that a request must be submitted and approved in advance before your insurance company will pay for a medication. How do I know if I need a prior authorization? o Contact your insurance company or pharmacist to find out. How do I get prior authorization? o Your prescriber must request the prior authorization. Your pharmacist can support you in coordinating with the prescribing office and checking on the status of your authorization. Does prior authorization guarantee that my Truvada will be approved? o No. Even if you do everything right, the insurance company may still refuse to cover your medicine. In the end, the insurance company is the one making the decision. o Gilead personnel will partner with you to contact your insurance company in order to help you understand/navigate your coverage through the Medication Assistance Program line What do I do if prior authorization does not work? There is hope. If you have exhausted all avenues listed above, and the cost of accessing PrEP is still too high, Gilead may be able to help. If none of the above options work: Truvada for PrEP Medication Assistance Program: Must not have insurance or have an insurance that does not cover Truvada. Application required including documenting proof of residency, proof of income, prescriber info, prescription and HIPAA. Must also make less than 200% of the Federal Poverty Level. Will cover 90 days of medication during Medi-Cal application process. If Medi-Cal is denied or not yet approved after 90 days, access will be extended to 6 months. Call , Monday through Friday between 9:00 a.m. and 8:00 p.m. EST. Special Exception If all of the listed options have been exhausted without success, a written request for a special exception can be submitted as a part of an appeals process. This letter can be submitted with the Medication Assistance Program application and should include: A description of why you need assistance and amount of time that assistance is needed. A list of all monthly expenses (no expense is too small). Whether or not you are currently on PrEP and if so, how has it been covered? Important to note whether you are coming off of a Gilead study. List other medications you are taking, how they are being paid for, generic vs. name brand. Maximum approval for a special exception is 6 months, after which you must re-apply. Special exceptions are not intended to be a sustainable solution. Explore an insurance option that works for you. THIS RESOURCE GUIDE IS MADE POSSIBLE BY THE FOLLOWING: