Who: Medicare beneficiaries, including seniors and individuals with disabilities.
What: Medicare Part B has expanded its coverage to include pre-exposure prophylaxis (PrEP) medications and related services.
When: The expanded coverage for PrEP under Medicare Part B took effect on Monday, September 30. This means that Medicare beneficiaries can now access these services without cost-sharing from that date onward. If you or someone you know is eligible, it’s a great time to start taking advantage of this new benefit!
Schedule an appointment with a healthcare provider to discuss the need for PrEP. The provider will assess the individual’s risk for HIV and determine if PrEP is appropriate. We are here for you! Schedule your PrEP assessment at www.swcenter.org/appointment
A Groundbreaking Step That Eliminates Out-of-Pocket Costs.
In a groundbreaking move for HIV prevention, Medicare Part B has now expanded to cover pre-exposure prophylaxis (PrEP) medications and related services. This policy change, announced on Monday, September 30, will significantly benefit Medicare beneficiaries who seek access to PrEP care but previously faced financial barriers.
PrEP was formerly covered under Medicare Part D, where patients were often subject to high deductibles and co-pays. Now, under Medicare Part B, these out-of-pocket expenses, including co-pays and deductibles, have been eliminated, making it easier than ever for patients to access essential HIV prevention care.
What Medicare Part B’s PrEP Coverage Includes
This enhanced coverage allows Medicare beneficiaries to access the following services without any cost-sharing:
PrEP Medication: Both oral and injectable PrEP drugs are covered, making them available to individuals who need ongoing HIV prevention.
Medication Dispensing: Coverage includes the supplying or dispensing of the PrEP prescription, eliminating additional costs for patients.
Individual Counseling: Beneficiaries can receive up to eight counseling sessions per year, focusing on HIV risk assessment, prevention strategies, and medication adherence.
HIV Testing: FDA-approved lab or point-of-care HIV testing is covered up to eight times a year, providing essential regular monitoring for individuals on PrEP.
Hepatitis B Virus Screening: As part of the preventive care package, a one-time Hepatitis B Virus (HBV) screening is also included, as individuals at risk for HIV can be at higher risk for HBV.
Expanding Access to HIV Prevention
The shift of PrEP coverage to Medicare Part B will help reduce barriers for Medicare beneficiaries—especially seniors and those with disabilities—who previously encountered cost and access issues under Part D. PrEP is a highly effective prevention method for HIV, reducing the risk of infection by up to 99% when taken consistently. This change represents a major advancement in public health, helping to increase access to life-saving HIV prevention and providing equitable care for more people in the Medicare system.
For Medicare beneficiaries and healthcare providers alike, this is an encouraging step forward in the fight against HIV, helping to create a future with fewer barriers to essential preventive care.