From CMS
Medicare Part B Coverage of Pre-exposure prophylaxis (PrEP) for HIV prevention
If your doctor or other health care provider determines you're at an increased risk for HIV, Medicare Part B (Medical Insurance) covers PrEP medication and related services. If you qualify, covered services include:
- FDA-approved oral or injectable PrEP medication.
- Up to 8 individual counseling sessions every 12 months.
- Up to 8 HIV screenings every 12 months.
- A Hepatitis B virus screening.
PrEP medications and related services are considered preventive care, so you pay nothing for them if your provider accepts assignment. If you get your drugs at the pharmacy and the pharmacy is enrolled in Medicare Part B, there is no out-of-pocket cost to you for the antiretroviral drugs.
What You Need to Know
When getting your PrEP prescription filled, make sure your pharmacy is enrolled in the Medicare program and can submit claims to Medicare Part B. If you find that your pharmacy is not enrolled in Medicare Part B and therefore does not cover the PrEP prescription at no cost, we encourage you to call 1-800-Medicare.
For more information see the new flyer:
What to do if Your Pharmacy Isn’t Enrolled in Medicare Part B
If you go to a pharmacy and they can’t bill Medicare for PrEP, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. We’ll help you find another pharmacy where you can get your PrEP.
Want more details? Read the Decision Memo.