September 30, 2024: HHS Centers for Medicare and Medicaid Services finalized a National Coverage Determination for HIV PrEP — Under this NCD, CMS will cover all forms of PrEP that are approved for use by the FDA for any Medicare recipient (Medicare is coverage for older adults and people with disabilities) at risk for HIV (as determined by the person’s medical provider). The NCD means that coverage will be without cost sharing (deductibles, copays, coinsurance) and CMS will also cover medical services associated with administration of injectable PrEP, up to eight HIV tests per year, up to eight HIV counseling sessions per year, and an annual Hep B screening.

This decision follows US Preventive Services Task Force’s recent Grade A recommendation for PrEP, which said that “PrEP is safe and highly effective at preventing HIV.”

Read the full National Coverage Determination for HIV PrEP, here: NCA – Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus (HIV) Infection (CAG-00464N) – Decision Memo (cms.gov).

Read on HIV.gov here: NEW: Medicare Part B Coverage of Pre-exposure Prophylaxis (PrEP) for HIV Prevention