Pre-exposure prophylaxis (PrEP) for HIV prevention
Medicare Part B (Medical Insurance) covers pre-exposure prophylaxis (PrEP) medication and related services, if you’re eligible
Description
PrEP uses antiretroviral medication to lower your risk of getting HIV. When taken as prescribed, PrEP is highly effective for preventing HIV.
Coverage details
Part B (Medical Insurance) covers pre-exposure prophylaxis (PrEP) medication and related services.
If you qualify, covered services include:
- FDA-approved oral or injectable PrEP medication. If you’re getting an injectable drug, Part B also covers the fee for injecting the drug.
- Up to 8 individual counseling sessions (including HIV risk assessment, HIV risk reduction, and medication adherence).
- Up to 8 HIV screenings.
- A hepatitis B virus screening.
Who's eligible
If you don’t have HIV, but your doctor or other health care provider determines you're at an increased risk for HIV.
Costs
If you get PrEP medications from a pharmacy that’s enrolled in Part B, you’ll pay nothing out of pocket for your medications. Ask your health care provider to include a diagnosis code on your prescription to help the pharmacy. If you’re in a Medicare Advantage Plan , you’ll pay nothing out of pocket for PrEP at any pharmacy in your plan’s network.
If your provider accepts assignment , you’ll also pay nothing out of pocket for injectable PrEP drugs, HIV and Hepatitis B virus screenings, and counseling sessions because they’re preventive services.
How often
If you qualify, you can get
- Up to 8 counseling sessions every 12 months.
- Up to 8 HIV screenings every 12 months.
- A one-time hepatitis B virus screening (you may be able to get more screenings if you're at high risk for Hepatitis B virus or you're pregnant).