CMS Announces Changes to PrEP Coverage
Starting September 30, Medicare changed the way it covers certain services that can reduce an individual’s risk of acquiring HIV. Previously, Pre-exposure Prophylaxis (PrEP) using antiretroviral drugs was covered under Part D and was subject to regular cost sharing. Now, FDA-approved PrEP using antiretroviral drugs and the administration of injectable PrEP are covered under Part B as a preventive service. In addition, for people using or being assessed for PrEP to prevent HIV, the updated coverage also includes up to eight individual counseling and regular HIV screenings every 12 months and a single screening test for hepatitis B.
This change means that these important services will now be available to people at an increased risk of acquiring HIV with no deductible, copay, or coinsurance. Note, however, that individuals who have HIV and who take antiretroviral drugs to treat HIV will continue to access those medications through their Part D plan, and they may be subject to deductibles and cost sharing. This is true even though the medications used for HIV treatment may be the same as those prescribed for HIV PrEP.
Most pharmacies can bill Part B, but it is a good idea for people accessing PrEP under this benefit for the first time to confirm with their provider to ensure it is processed properly as a preventative service.
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