Effective September 30, 2024, CMS finalized its National Coverage Determination (NCD) for PrEP, which moves coverage for PrEP from Medicare Part D to Part B and requires reimbursement for certain HIV preventative services without cost-sharing to beneficiaries. Medicare will reimburse for all forms of PrEP (oral and long-acting), up to eight counseling visits, and up to eight HIV screenings per year. CMS had proposed seven counseling visits and screenings annually. The NCD will also provide a single screening for hepatitis B virus.  The NCD also clarifies that Medicare will cover all future long-acting forms of PrEP, which is notable because there are new formulations of long-acting PrEP in the development pipeline.

Pharmacies that are not already enrolled in Part B, and want to provide, or continue to provide PrEP, must enroll. Instructions for enrollment are here:  Medicare Provider Enrollment Instructions.  CMS projects that the enrollment process will take about 45 days.

CMS has published a fact sheet and frequently asked questions to assist pharmacies with this transition. These resources provide further information on enrolling and billing under Medicare Part B.

The Powers 340B team will continue to monitor HIV preventative coverage issues and the provision of PrEP under the NCD.