Medicare Coverage of HIV Pre-exposure Prophylaxis (PrEP):

Medicare Coverage of HIV Pre-exposure Prophylaxis (PrEP): Information for Patients, Providers, and Pharmacists Coverage of PrEP in Medicare: Transition to Coverage in Part B The federal Centers for Medicare and Medicaid Services (CMS) have issued a final National Coverage Determination (NCD) for PrEP directing Medicare to cover all forms of PrEP (oral and injectable) through Medicare Part B, the p. [...] Tests ordered under this coverage must be considered “reasonable and necessary” for the individual patient, and may be subject to Medicare Part B’s usual deductible and coinsurance requirements.5 What should pharmacies do to ensure that they can fill prescriptions for PrEP under Medicare Part B? Pharmacies that dispense PrEP should ensure that they are enrolled in Medicare as either: 1) a durable. [...] Since enrollment in Part B is a multi-step process and takes time, pharmacies seeking to enroll as a Part B Pharmacy supplier in order to continue providing PrEP for Medicare patients should begin the process as soon as possible. [...] traditional Medicare) who need to locate a pharmacy that accepts Part B for PrEP are encouraged to call 1-800-MEDICARE (1-800-633-4227), or to use Medicare’s supplier director to locate a pharmacy that accepts Medicare coverage for medical equipment and supplies. [...] Information for Medicare Advantage Plan Members PrEP users with Medicare Advantage plans may need to use an in-network provider and pharmacy to obtain PrEP through Medicare Part B and avoid cost sharing.