HIV+Hep in the News

“Today’s announcement marks a huge step in ensuring Medicare beneficiaries who want to protect themselves against HIV by using either daily oral or long-acting PrEP can do so without cost-sharing. As people are living longer and remain sexually active, it is important that anyone who has a reason to be on PrEP can access it,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement shared with Becker’s.

The new proposal by CMS “marks a huge step in ensuring Medicare beneficiaries who want to protect themselves against HIV by using either daily oral or long-acting PrEP can do so without cost sharing,” said Carl Schmid, executive director of the HIV+Hep Policy Institute, in the group’s press release. “Currently, Medicare beneficiaries are only guaranteed access to daily oral PrEP through Part D and face out-of-pocket costs, and long-acting injectable PrEP has not generally been covered,” Schmid said, adding that if the coverage is finalized, it “would close the gap in the future between FDA [Food and Drug Administration] approval and coverage of new PrEP drugs by Medicare Part B.

Currently, Medicare beneficiaries are only guaranteed access to daily oral PrEP through Part D, facing out-of-pocket costs, said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. Injectable PrEP has not been covered traditionally. Schmid praised the proposal’s details July 12 in a statement to Fierce Healthcare. “Today’s announcement marks a huge step in ensuring Medicare beneficiaries who want to protect themselves against HIV by using either daily oral or long-acting PrEP can do so without cost-sharing,” he said. “As people are living longer and remain sexually active, it is important that anyone who has a reason to be on PrEP can access it. In addition to covering the drugs without cost sharing, we are pleased that CMS heeded our suggestion that the coverage determination encompass PrEP ancillary services, including periodic medical and counseling visits along with HIV and hepatitis B testing.”

The U.S. Centers for Medicare & Medicaid Services proposed a national coverage determination, which would require all Medicare plans to cover, without beneficiary cost-sharing, all HIV prevention medications. Currently, Medicare beneficiaries are only guaranteed access to daily HIV prevention pills through Part D plans and also face out-of-pocket costs, while long-acting injectable medicines have not generally been covered. “As people are living longer and remain sexually active, it is important that anyone who has a reason to be on PrEP can access it,” said Carl Schmid, who heads the HIV+Hepatitis Policy Institute.