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·News & Announcements
Effective date
Jun 18, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans now provide preventive coverage for Lenacapavir (Yeztugo) for Pre-exposure Prophylaxis (PrEP) to prevent HIV infection. This coverage is retroactively effective to June 18, 2025, meaning claims can be submitted for services provided since that date.
Action Required
Immediately: Billing team should verify Lenacapavir (Yeztugo) PrEP claims can be submitted to Medicare Advantage plans with preventive benefit coding. Review any denied claims from June 18, 2025 forward for potential resubmission. Contact Medicare Advantage plans to confirm specific billing requirements and NDC codes for Lenacapavir coverage.