Pre-exposure prophylaxis (PrEP) for HIV prevention
If you don’t have HIV, but your doctor or other health care practitioner determines you're at an increased risk for HIV, 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) every 12 months.
- Up to 8 HIV screenings every 12 months.
- A one-time hepatitis B virus screening.
Your costs in Original Medicare
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 doctor or health care practitioner 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 the HIV and hepatitis B virus screenings or the counseling sessions because they’re preventive services.
What it is
PrEP uses antiretroviral medication to lower your risk of getting HIV. When taken as prescribed, PrEP is highly effective for preventing HIV.