Potential for Medicare Part B Coverage of Preexposure Prophylaxis (Prep) Using Antiretroviral Therapy (Oral or Injectable) to Prevent Human Immunodeficiency Virus (HIV)

The Centers for Medicare & Medicaid Services (CMS) is sharing information to encourage pharmacies and other interested parties to prepare for a potential National Coverage Determination (NCD) for Preexposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent HIV.

Pharmacies To bill for oral HIV PrEP drugs under Part B, a pharmacy must be enrolled in Medicare as either: 1) a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier (CMS-855S), or 2) a Part B Pharmacy supplier (CMS-855B).

Source: https://www.cms.gov/files/document/fact-sheet-potential-medicare-part-b-coverage-preexposure-prophylaxis-prep-using-antiretroviral.pdf