Preventive Services

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 expect to release a final National Coverage Decision (NCD) in late September 2024, and we expect the final NCD will be similar to the proposed NCD. 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 NCD.

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

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Talk to your patients about which preventive services are right for them and how often they need them.

If you’re a person with Medicare, learn about all preventive services.

Learn more about billing for Medicare-covered preventive services:

Shots & vaccines
Wellness visits
Diabetes-related services
Tests & screenings
Counseling & therapies
Mental health services


Page Last Modified:
07/02/2024 02:42 PM