Medicare Now Paying for PreP

[chitownguy]

I've have been paying for my PreP prescription out of pocket using a GoodRx coupon.  The copay on my Part D plan was $150/month.  Yesterday when I picked up my refill the pharmacist told me I no longer have to pay anything since Medicare Part B now pays the total cost.  This great news.  I'm now considering switching to the injectable form of PreP to avoid taking a daily pill.

https://www.hiv.gov/blog/now-medicare-part-b-coverage-pre-exposure-prophylaxis-prep-for-hiv-prevention

[+ robear]

Thank you for this, I'll check into it further.  My current Med D plan "covers" PrEP, but requires nearly $1K/month copay.  Instead I get 3 months of generic Truvada at Cost Plus Drugs for $36.  The caveat here might be determining which pharmacies, retail or mail order, will process a Med B claim.  But still it's good information and a step forward.

[chitownguy]

38 minutes ago, robear said:

Thank you for this, I'll check into it further.  My current Med D plan "covers" PrEP, but requires nearly $1K/month copay.  Instead I get 3 months of generic Truvada at Cost Plus Drugs for $36.  The caveat here might be determining which pharmacies, retail or mail order, will process a Med B claim.  But still it's good information and a step forward.

Yes the pharmacy would have to be a Part B provider.  The large national chains Walgreens, CVS  etc. are enrolled in Part B.  I get mine prescription from Walgreens. If you get injectable Prep from your physician or a clinic, they would have to accept Medicare assignment.

[jeezifonly]

https://www.axios.com/2024/10/03/medicare-drug-coverage-2025-changes

No matter who’s elected this Nov, there’s a plan that takes effect in January. Huge savings on Rx for all MediCare members. 

[Atyla]

Smart move ahead of the elections. I'm on medicare too and it's such a basic medication, that it had always should have had a small copay, or no copay. It's good that they're finally accepting people over 65 are also sexually active, and quite sexually active at that. We deserve easy access to this medication just like anyone else. It's good that they stepped up their game and came to their senses. I had been paying quite a lot of money too. This is amazing news.

[+ WstVlgChris]

Amazing savings over the old system: I used to pay more than $300 for 30 pills through Medicare Pt.D; now I pay 0, zilch, nada--regular MedicareB covers it all!

[+ robear]

Agree, great benefit … for now.  I don’t expect it to last in the current environment

[+ sniper]

If you google generic truvada goodrx you will find you can get it for well under $50 a month without insurance now. The pharmacy benefit managers at many employer plans, however, steer the plans to the ones that still cost a thousand a month. It should be criminal. It's a tremendous waste of healthcare dollars. Do the nonprofits get a cut or something?

[MikeBiDude]

I’m getting mine from amazon pharmacy for like $30-$50 for a month, better than the $300/month before Medicare covered it. 

[Archangel]

But not GLP-1s for weight management. 

[+ JamesB]

I just paid $70.54 for a 90 day supply of generic Truvada at CVS using GoodRx.

[+ robear]

If you’re not eligible for the no-cost Medicare B benefit, current price for 90 days at Cost Plus Drugs is 32.19 + 5.00

https://www.costplusdrugs.com/medications/emtricitabine-tenofovir-df-200mg-300mg-bottle-of-tablets/

[marylander1940]

On 5/9/2025 at 10:13 PM, MikeBiDude said:

I’m getting mine from amazon pharmacy for like $30-$50 for a month, better than the $300/month before Medicare covered it. 

$55 a month on "all day chemist" for a almost a decade.

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Edited May 11 by marylander1940