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StateFormulary LinkCurrent Document
Last Updated
Apretude (Cabotegravir)Apretude PA RequiredCabenuvaCabenuva PA RequiredEgrifta (Tesamorelin)Egrifta PA RequiredSerostim (Somatropin)Serostim PA RequiredSunlencaSunlenca PA RequiredTrogarzoTrogarzo PA RequiredNotes
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AlabamaLinkLink01/01/23
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AlaskaLinkLink2023
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ArizonaLinkLink07/28/23
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ArkansasLinkLink11/01/22
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CaliforniaLinkLink08/23/23
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ColoradoLinkLink06/30/21
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ConnecticutLinkLink08/02/23
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DelawareLinkLink01/01/23
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District of ColumbiaLinkLink04/05/23
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FloridaLinkLink09/01/23
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GeorgiaLinkLink08/10/23
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HawaiiLinkLink07/01/23
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IdahoLinkLink08/25/23
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IllinoisLinkLink07/01/23Open Formulary
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IndianaLinkLink06/16/23
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IowaLinkLink12/01/22Open Formulary
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KansasLinkLink10/01/18Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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KentuckyLinkLink11/19/21
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LouisianaLinkLink01/01/23
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MaineLinkLink05/01/23
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MarylandLinkLink02/19/20Old formulary website is a broken link. Will email for Cabenuva and Sunlenca coverage information. Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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MassachusettsLinkLinkOpen Formulary
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MichiganLinkLink05/22/23
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MinnesotaLinkLink10/08/23Open Formulary
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MississippiLinkLink03/01/22
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MissouriLinkLink05/15/23Cabenuva not covered; Sunlenca and Trogarzo are covered, but only through limited distriubtion.
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MontanaLinkLink09/04/19
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NebraskaLinkLinkOpen Formulary
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NevadaLinkLink10/02/20Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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New HampshireLinkLink07/01/23Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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New JerseyLinkLinkCurrent data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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New MexicoLinkLinkCurrent data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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New YorkLinkLink11/01/21
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North CarolinaLinkLink06/28/23
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North DakotaLinkLink08/01/19Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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OhioLinkLink10/01/21Open Formulary with some restrictions. Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications

Egrifta & Serostim excluded from coverage
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OklahomaLinkLink01/01/14Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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OregonLinkLinkOpen Formulary
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PennsylvaniaLinkLink10/01/23
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Rhode IslandLinkLink03/31/21Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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South CarolinaLinkLink07/01/22Covered for ADAP IAP and MAP enrollees ONLY! Prior authorization as a pharmacy benefit may be required from the enrolleeā€™s health insurance provider prior to dispensing.

Optional oral lead-in is coordinated through TheraCom Pharmacy at no cost.

Cabenuva is available through a limited distribution network of pharmacies. SC ADAP enrollees should ensure they select one of the ADAP IAP Participating Pharmacies that is also on the ViiV Specialty Pharmacy Network list (currently, this includes Avita and CVS Specialty).

SC ADAP does not cover the medical administration fee for the medication. The use of copay cards is not allowed for persons in SC ADAP.
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South DakotaLinkLink04/01/22Current data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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TennesseeLinkLink07/15/22
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TexasLinkLink07/01/23Open Formulary
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UtahLinkLinkCurrent data pulled from the NASTAD formulary database: https://nastad.org/adap-formulary-database/antiretroviral-medications
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VermontLinkLink04/01/22
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VirginiaLinkLink09/26/23Open Formulary
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WashingtonLinkLink01/01/22
Egrifta will not be approved for cosmetic use or weight loss
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West VirginiaLinkLink12/01/20
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WisconsinLinkLink04/11/23
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WyomingLinkLink01/01/21Open Formulary

Egrifta excluded
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