Medicare AdvantageCoverageMedium impact
New Preventive Coverage of Lenacapavir (Yeztugo) for Pre-exposure Prophylaxis (PrEP) for the Prevention of HIV Infection for Medicare Advantage members (Retroactively Effective to June 18, 2025)
Independence Blue Cross·Infectious Disease, Internal Medicine, Family Medicine +1 more·News & Announcements
Effective date
Jun 18, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans are now providing preventive coverage for Lenacapavir (Yeztugo) as pre-exposure prophylaxis (PrEP) for HIV prevention, retroactively effective to June 18, 2025. This is a new covered preventive service for eligible Medicare Advantage members with no cost-sharing requirements.
Action Required
By September 30, 2025: Billing team must verify Lenacapavir (Yeztugo) PrEP administration claims for Medicare Advantage members are being processed as preventive services with zero cost-sharing. Update billing system and claim submission protocols to reflect this retroactive coverage. Contact your Medicare Advantage plan contacts to obtain specific HCPCS/CPT billing codes and any prior authorization requirements for this drug. Providers should identify and resubmit any denied or patient-cost-shifted claims from June 18, 2025 forward for eligible MA members. Failure to apply correct coverage may result in improper member billing or claim denials.