Efficient September 30, 2024, the Facilities for Medicare & Medicaid Providers (CMS) started masking PrEP as a preventive service below Medicare Half B with no out-of-pocket prices. Preexposure Prophylaxis (PrEP) is very efficient in decreasing the danger of getting HIV. Beforehand, PrEP was solely lined below Medicare Half D and included important out-of-pockets prices.
CMS’s choice to categorize PrEP and associated ancillary testing and screenings as preventive providers below Half B goals to enhance entry to PrEP and deal with disparities in entry that exist as we speak for Medicare enrollees who can not afford it.
Beneath the change, Medicare will cowl the next providers with out cost-sharing:
- PrEP (oral or injectable) for people at excessive threat of HIV acquisition
- Administration of injectable PrEP
- Particular person counseling visits (as much as 8 visits each 12 months) together with:
- HIV threat evaluation
- HIV threat discount
- Treatment adherence
- HIV screenings (as much as 8 occasions each 12 months)
- Single Hepatitis B virus screening
CMS has offered quite a few sources and coaching to pharmacies to assist put together them for this alteration. Nonetheless, disruptions are nonetheless doable. Individuals utilizing PrEP ought to discuss to their pharmacist to test if they will fill their prescription and choose one other pharmacy in the event that they expertise any points. They will additionally report any points in filling their prescription to 1-800-MEDICARE.
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