PrEP on Medicare

[+ robear]

Anyone with experience getting PrEP meds on Medicare free or cheap?  It has always been free for me on my group health insurance, as it is for many commercial insurance plans.  The meds are "covered" on Med D and Advantage plans (I think by law), but still entail hundreds a month in copays in every plan I've looked at.  All the copay refund programs etc. specifically exclude Medicare recipients.  So what's an old slut to do?

The cheapest I've found, bypassing insurance altogether, is Mark Cuban's Cost Plus Drugs site, which offers generic Truvada for $16.10/month, $38.30/90 days.  That is of course quite affordable, but I wonder if any fellow horny old coots has a better solution.

[chitownguy]

Last July Medicare issued a draft proposal to pay for PreP both oral and injectable under Part B.   They would cover it without any out of pocket cost along with the related HIV testing.  They were suppose to issue the final rule last October but so far they haven't.

CMS Proposes Medicare Coverage for PrEP, Invites Public Comment by August 11

WWW.HIV.GOV

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On July 12, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the posting of a proposed Nat...

 

[+ robear]

That's very interesting, thank you.  Will monitor progress ...

[MikeBiDude]

3 hours ago, robear said:

Anyone with experience getting PrEP meds on Medicare free or cheap?  It has always been free for me on my group health insurance, as it is for many commercial insurance plans.  The meds are "covered" on Med D and Advantage plans (I think by law), but still entail hundreds a month in copays in every plan I've looked at.  All the copay refund programs etc. specifically exclude Medicare recipients.  So what's an old slut to do?

The cheapest I've found, bypassing insurance altogether, is Mark Cuban's Cost Plus Drugs site, which offers generic Truvada for $16.10/month, $38.30/90 days.  That is of course quite affordable, but I wonder if any fellow horny old coots has a better solution.

I paid for it using Medicare for a couple years. Was hundreds of dollars a year with deductible, it was a “Tier 4” drug.  So with that level and gap coverage etc. was very expensive. Also note the Gilead deductible benefit goes away with Medicare, they don’t offer any help with “government” sponsored insurance plans.

So, for me it’s Amazon Pharmacy at $48 for 90 day supply. I just pay it out of pocket and don’t even turn in to Medicare.

[Luv2play]

16 minutes ago, MikeBiDude said:

I paid for it using Medicare for a couple years. Was hundreds of dollars a year with deductible, it was a “Tier 4” drug.  So with that level and gap coverage etc. was very expensive. Also note the Gilead deductible benefit goes away with Medicare, they don’t offer any help with “government” sponsored insurance plans.

So, for me it’s Amazon Pharmacy at $48 for 90 day supply. I just pay it out of pocket and don’t even turn in to Medicare.

At $16 per month, that’s about the price of a good glass of wine in a decent restaurant with tip. 

[Rudynate]

I was getting a generic from India - I think $75 for 90 days.  This was back before it became so affordable in the US. I don't think I would bother with getting it offshore now.

[+ sniper]

On 3/29/2024 at 8:25 AM, robear said:

Anyone with experience getting PrEP meds on Medicare free or cheap?  It has always been free for me on my group health insurance, as it is for many commercial insurance plans.  The meds are "covered" on Med D and Advantage plans (I think by law), but still entail hundreds a month in copays in every plan I've looked at.  All the copay refund programs etc. specifically exclude Medicare recipients.  So what's an old slut to do?

The cheapest I've found, bypassing insurance altogether, is Mark Cuban's Cost Plus Drugs site, which offers generic Truvada for $16.10/month, $38.30/90 days.  That is of course quite affordable, but I wonder if any fellow horny old coots has a better solution.

If it's available that cheaply, I'd gladly pay the out of pocket just to screw over the bloated pharmacy benefit management boondoggle. It blows my mind that employers are still paying a thousand bucks a month for "generic" Prep.