PrEP Treatment Transitions From Medicare Part D to Medicare Part B

Pre-exposure Prophylaxis (PrEP) coverage has transitioned from Medicare Plan D to Plan B. Providers now need to include the PrEP ICD-10 code with every prescription to have the prescription paid for through Part B.

The Centers for Medicare & Medicaid Services (CMS) approved PrEP anti-retroviral drugs (oral or injectable) to prevent HIV in high-risk individuals. CMS will cover these services without member cost-sharing.

• FDA-approved PrEP using anti-retroviral drugs (oral or injectable) to prevent HIV in individuals at high risk of HIV acquisition.
• Administration of injectable PrEP using anti-retroviral drugs to prevent HIV.
• Supplying the drug regardless of the route of administration (oral and injectable).
• Individual counseling (up to 7 visits every 12 months), including:
  • HIV risk assessment (initial or continued assessment of risk)
  • HIV risk reduction
  • Medication adherence
• HIV screenings (up to 7 times every 12 months using FDA-approved laboratory tests and point-of-care tests).
• Hepatitis B virus screening (1 time only).

To find out more, visit the CMS.gov website.