Physician Center



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.

Important Links

Accountable Care Organizations Workshop

Value-Based Purchasing Information

Page Last Modified:
09/27/2023 01:48 PM