Preventive Services

PrEP for HIV: Prepare for Potential Medicare Part B Coverage

On July 12, 2023, CMS proposed to transition coverage of Preexposure Prophylaxis (PrEP) using FDA-approved antiretroviral drugs (oral or injectable) to prevent HIV to Medicare Part B. Currently, HIV PrEP drugs may be covered under Medicare Part D.

It’s critical that your patients have uninterrupted access to their HIV PrEP drugs. We’re encouraging you to prepare your systems now so you’re able to immediately transition to Part B coverage if we release a final National Coverage Decision (NCD).

Review our fact sheet (PDF) to learn more about how you can prepare for the possible upcoming coverage change, including information about enrollment, billing, claims processing, and coding.