On September 30, 2024, the Centers for Medicare & Medicaid Services (CMS) announced its decision to cover all forms of Pre-Exposure Prophylaxis (PrEP) as a preventive service under Medicare Part B without cost-sharing.
Previously, PrEP was only covered under Medicare Part D, which required patients to pay substantial out-of-pocket costs to access the medication. However, CMS has reaffirmed that PrEP is highly effective in lowering the risk of contracting HIV, and determined it is reasonably necessary for the prevention of an illness or disability. As such, CMS announced Medicare Part B will cover the cost of HIV PrEP using antiretroviral drugs, including the supplying or dispensing of these drugs and the administration of injectable PrEP.
In addition, CMS announced the following additional preventative services would also be covered as preventative care: (1) up to eight individual counseling visits every 12 months, that include HIV risk assessment (initial or continued assessment of risk), HIV risk reduction, and medication adherence; (2) up to eight HIV screening tests every 12 months; and (3) a single screening for hepatitis B virus (HBV).
Aimed Alliance supports this decision and urges CMS to ensure that Medicare Advantage plans do not impose unnecessary barriers such as prior authorization or step therapy that could restrict access to PrEP under Part B. Learn more about the decision.
Last Updated on October 7, 2024 by Aimed Alliance
