Medicare Coverage Expansion: Pharmacists Provide HIV Prevention Services (PrEP/PEP).
This act expands Medicare coverage to include HIV prevention services, such as PrEP and PEP, when provided directly by pharmacists. This change increases convenience and access for Medicare beneficiaries, allowing them to receive screenings, consultations, and preventive medications at pharmacies. These services will be covered under Medicare Part B, reducing out-of-pocket costs for eligible individuals.
Key points
Medicare Part B will cover HIV prevention services (including PrEP and PEP) furnished by legally authorized pharmacists.
Beneficiaries will generally be responsible for the standard 20% co-insurance for these pharmacist-provided services.
The law prohibits pharmacists from 'balance billing' patients (charging the difference between the actual cost and the Medicare-approved amount).
The new coverage rules apply to services furnished on or after January 1, 2027.
Introduced
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