Pre-exposure prophylaxis (PrEP) for HIV prevention
Medicare Coverage Information
Overview
Medicare provides coverage for Pre-Exposure Prophylaxis (PrEP), a medication that helps prevent HIV infection for individuals at high risk. Beneficiaries can access PrEP medications with certain conditions and potential cost-sharing requirements.
- PrEP is covered under Medicare as a preventive health service
- Requires a prescription from a healthcare provider
- Typically covered under Medicare Part B or Part D
- Annual HIV risk assessment may be required
- Covers medication and associated laboratory tests
- Medicare beneficiaries at substantial risk of HIV infection
- Individuals with documented high-risk behaviors
- Must have a prescription from a healthcare provider
- Applicable to Original Medicare and some Medicare Advantage plans
- May be subject to Part B deductible
- Potential coinsurance of 20% for medication and related services
- Some Medicare Advantage plans might offer lower copayments
- Must be prescribed by a qualified healthcare provider
- Patient must meet specific HIV risk criteria
- Regular follow-up and HIV testing required
- Coverage may vary by specific Medicare plan
- Consult with your healthcare provider about PrEP eligibility
- Discuss HIV risk assessment with your doctor
- Verify specific coverage details with your Medicare plan
- Contact Medicare at 1-800-MEDICARE for specific coverage questions
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare PrEPHIV preventionMedicare preventive carePre-exposure prophylaxisMedicare Part B coverage
Related Coverage Topics
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