As of September 2024, Medicare has covered FDA-approved Pre-exposure Prophylaxis (PrEP) oral or injectable antiretroviral drugs such as Truvada, as well as counseling sessions for HIV risk assessment, medication adherence, and HIV screenings.
Truvada is a brand name for the medications tenofovir disoproxil fumarate and emtricitabine. Doctors prescribe it to reduce as well as prevent viral infections, such as HIV. It can be part of the “preexposure prophylaxis” or PrEP approach for HIV.
For Medicare to cover Truvada, a person usually needed to have prescription drug coverage (Medicare Part D) or an Advantage plan (Medicare Part C) that covers drug prescriptions. However, as of the fall of 2024, such drugs have been fully covered under Part B.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Truvada is an antiretroviral drug. Traditionally, Part D or Medicare Advantage (Part C) with prescription drug coverage covers antiretrovirals like Truvada.
Many of these plans have high levels of cost-sharing and out-of-pocket expenses for this drug. A 2020 study noted that previous research estimates that less than
However, as of September 2024, Medicare has updated its coverage for PrEP. Instead of getting HIV PrEP through Part D and paying a deductible and coinsurance or copayments, Medicare Part B now covers them without cost-sharing.
According to the Centers for Medicare & Medicaid Services (CMS), Medicare covers the following:
- PrEP services: FDA-approved antiretroviral drugs, such as Truvada, to prevent HIV in individuals with a high chance of acquiring HIV.
- Individual counseling: Up to 8 visits of counseling every 12 months for HIV-related issues.
- Screening: Up to 9 screenings for HIV every 12 months using FDA-approved laboratory tests.
- Hepatitis B: One screening is also covered under this benefit.
It’s important to understand, however, that this coverage is available to people with a higher chance of acquiring HIV. People already living with HIV and taking medications continue getting their drugs through Part D or Part C plans that include drug coverage.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The cost of Truvada varies depending on the dosage, region, and insurance plans. A
That said, under Part B, a person can now get Truvada without cost sharing. This means that Part B will fully cover the cost, which won’t count toward a person’s deductible. In addition, a person won’t have any copays. That said, a person still has to pay the monthly premium for Part B, which starts at $185 in 2025.
A person living with HIV continuing to purchase medications through Parts C or D does, generally, have to meet a deductible and incur some kind of copay. As with Part B, they also have to pay a premium. A person’s costs under these plans vary depending on the plan and the manufacturer. The national base beneficiary premium is $36.78 in 2025, while the yearly deductible for any Medicare drug plan can’t exceed $590.
In addition, prescription drug plans will usually separate medications into tiers or pricing categories ranging from preferred generic, which are the least expensive medications, up to brand-name or specialty medications, which are high in cost. Truvada currently belongs in the high cost category as it is a brand-name drug.
However, medical providers introduced a generic formulation of tenofovir disoproxil fumarate and emtricitabine, Truvada’s active ingredients, in
Other options exist to help a person pay for antiretrovirals like Truvada. This includes the following:
- AIDS drug assistance programs: Also known as ADAPs, state-based programs help people living in low income households pay for out-of-pocket costs. Examples include help with copayments, coinsurance, deductibles, and premiums.
- Extra Help: Extra Help is a Medicare-sponsored program for those with limited income and resources to receive additional financial help paying for medications. Extra Help can mean a person pays no more than $12.15 per prescription in 2025 for a brand-name drug like Truvada.
- Medicaid: Medicaid is a federal- and state-sponsored program that helps individuals living in low income households receive help in paying for insurance costs, including prescription drugs.
- Gilead Advancing Access: Gilead, Truvada’s manufacturer, has a program called Advancing Access that assists insured, non-insured, and underinsured individuals. The program can help find ways to make Truvada more affordable whenever possible.
A person can also speak with their doctor about potential local assistance programs that can help pay for Truvada.
HIV and AIDS resources
For more in-depth information and resources on HIV and AIDS, visit our dedicated hub.
All Medicare prescription drug plans cover Truvada. However, plan premiums, copayments, and other out-of-pocket expenses remain the responsibility of the individual.
There are assistance programs available that can help make the medication more affordable and easier to access.
Since the fall of 2024, Medicare has covered PrEP medications such as Truvada as part of Medicare Part B. This means people at risk of acquiring HIV don’t need to pay copayments and other out-of-pocket expenses.
