medicare

We are pleased that the Centers for Medicare and Medicaid Services (CMS) has accepted a request for a National Coverage Determination (NCD) for cabotegravir, a new long-acting injectable form of pre-exposure prophylaxis (PrEP) to prevent HIV.  A National Coverage Determination is the only pathway to coverage under Medicare Part B for a provider-administered drug.  We have, however, been disappointed to learn that CMS has given no timeline for action on this National Coverage Determination, which will make this new long-acting PrEP medication out of reach for potential PrEP users.  Combined with a USPSTF recommendation, an NCD will also make the drug available to Medicare Part B beneficiaries without cost-sharing, thus eliminating one of the biggest barriers to PrEP uptake.