Human immunodeficiency virus (HIV) postexposure prophylaxis (PEP)

Washington State Health Care Authority sent this bulletin at 03/31/2026 05:47 PM PDT

March 31, 2026

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Human immunodeficiency virus (HIV) postexposure prophylaxis (PEP)

RCW 74.09.665 took effect on January 1, 2025, in accordance with the guidelines issued by the Centers for Disease Control and Prevention (CDC). This law helps increase access to human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) drugs or therapies.

RCW 74.09.665

How do I bill for take-home supply of HIV postexposure prophylaxis drugs or therapies?

Retroactive for dates of service on or after January 1, 2025, hospital emergency departments (EDs) may dispense and bill for up to a 28-day supply of HIV PEP drugs or drug therapies following a client’s possible exposure to HIV, unless the treatment is:

Medically contraindicated;
Inconsistent with accepted standards of care; or
Inconsistent with CDC guidelines.

EDs must bill for take-home HIV PEP drugs or drug therapies as a separate line
item with HCPCS code J8499 and the National Drug Code (NDC) for the products that were dispensed. The take-home HIV PEP is reimbursed separately from the bundled ED rate. See the Prescription Drug Program billing guide for more information.

Provider Billing Guides

Questions?

Please contact us at:

Email Apple Health Pharmacy

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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