Medicare PrEP coverage switch from Part D to Part B expected soon.

Prepare for Medicare billing changes for PrEP coverage

We encourage providers to prepare for the CMS proposed shift in Medicare coverage for Preexposure Prophylaxis (PrEP), the FDA-approved treatment using antiretroviral drugs to prevent HIV, from Part D to Part B.

On July 12, 2023, CMS released a proposal to transition PrEP coverage to Medicare Part B. Coverage under Part B will begin once the final National Coverage Determination (NCD) is released, which is expected in late September 2024.

For details, please refer to the CMS fact sheet and proposed NCD decision memorandum via their online tracking sheet.