Medicare to Cover All FDA-Approved HIV Prevention Drugs Without Cost-Sharing.

Oct. 1, 2024 – Washington, D.C. 

Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare will begin covering all forms of HIV Pre-Exposure Prophylaxis (PrEP) approved by the Federal Drug Administration (FDA) without cost-sharing. PrEP has been given a “Grade A” rating by the United States Preventive Services Task Force (USPSTF) because it is a safe and highly effective medication to prevent the acquisition of HIV. This announcement is important both because it reduces financial barriers to PrEP and because it applies to all current and future approved PrEP drugs, eliminating any delays in coverage for future PrEP medications.

The announcement marks a transition for PrEP coverage in Medicare. Until now, PrEP has been covered by Medicare Part D, Medicare’s pharmacy benefit. Beginning immediately, Medicare will cover all forms of PrEP that have been approved by the FDA, provider visits, and key screenings needed to start or renew a PrEP prescription without cost-sharing under Medicare Part B. Medicare Advantage plans will also be required to cover PrEP and related services without cost-sharing. This change means that pharmacies dispensing PrEP will need to be part of the Medicare Part B network.

Check out the CMS FAQ page for the full details on this decision.