CMS Proposes Medicare Coverage for PrEP, Invites Public Comment by August 11
On July 12, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the posting of a proposed National Coverage Determination for Pre-Exposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent Human Immunodeficiency Virus (HIV) Infection.
CMS proposes coverage of PrEP using antiretroviral drugs (whether oral or injectable) approved by the U.S. Food and Drug Administration (FDA) to prevent HIV infection in individuals at high risk of HIV acquisition. CMS also proposes to cover the administration of injectable PrEP using antiretroviral drugs to prevent HIV infection. PrEP involves the use of antiretroviral drugs on an ongoing basis or before and after HIV exposure. When taken as directed, PrEP is highly effective for preventing HIV. Further, CMS is also proposing to cover additional HIV screenings up to seven times annually and a single screening for hepatitis B virus (HBV) for these high risk patients.
PrEP medications are currently covered under Medicare Part D, but may have cost-sharing and deductibles. Under the proposal, both oral and injectable forms of the medication would be covered for certain individuals under Part B as an “additional preventive service,” and without requiring payment of Part B coinsurance or meeting the deductible. People with Medicare should talk to their doctor or health care provider to see if this medication is right for them.
You can find more details, and how to submit a comment on this proposed National Coverage Determination by August 11, 2023, at: https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=310