CMS proposes coverage for pre-exposure prophylaxis regimens to prevent HIV

The Cen­ters for Medicare and Med­ic­aid Ser­vices on Wednes­day pro­posed cov­er­age for pre-ex­po­sure pro­phy­lax­is (PrEP) us­ing an­ti­retro­vi­ral ther­a­py to pre­vent HIV in­fec­tions.

The news comes near­ly six months af­ter CMS ini­ti­at­ed a na­tion­al cov­er­age analy­sis for PrEP. Medicare cov­er­age for PrEP cur­rent­ly varies by plan, though many pa­tients are left with high out-of-pock­et costs. Ac­cord­ing to one 2020 study that an­a­lyzed a va­ri­ety of Medicare plans in the Ann Ar­bor, MI area, the av­er­age an­nu­al cost for some­one with a pre­scrip­tion drug plan was be­tween $2,276 and $2,430, in­clud­ing de­ductibles, month­ly pre­mi­ums, co­pays and coin­sur­ance.

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