Original Medicare, Medicare Advantage, and prescription drug (Part D) plans must cover generic emtricitabine/tenofovir disoproxil fumarate or brand name Truvada.

Truvada is the brand name of a prescription medication, emtricitabine/tenofovir disoproxil fumarate, used to prevent or treat HIV. It’s a type of medication known as an antiretroviral drug.

The amount you’ll pay for generic emtricitabine/tenofovir disoproxil fumarate or brand-name Truvada depends on:

  • how the drug is classified within your plan’s tier system
  • whether you have met your prescription drug deductible for the year
  • your eligibility for any programs that help could lower costs

Part B is medical insurance. As of September 30, 2024, Part B covers Pre-exposure Prophylaxis (PrEP) for HIV without cost-sharing.

So, if you’re using emtricitabine/tenofovir disoproxil fumarate (Truvada) to help reduce your risk of HIV, the medication is available at no out-of-pocket cost to you. You will not have a copayment or coinsurance cost.

You’ll still be responsible for your plan’s monthly premium. In 2025, most people will pay a monthly premium of $185, but your premium may be higher depending on your income.

Part C plans are required to cover the same basic services as Original Medicare, including PrEP for HIV. You will not have a copayment or coinsurance cost for preventive emtricitabine/tenofovir disoproxil fumarate (Truvada).

If you have a Part C or Medicare Advantage plan with prescription drug coverage (MA-PD), preventive emtricitabine/tenofovir disoproxil fumarate (Truvada) will still be covered under Part B.

If you’re using emtricitabine/tenofovir disoproxil fumarate (Truvada) to treat HIV, you may qualify for a Special Needs Plan (SNP). SNPs are a type of Part C plan that offers extra benefits to people with certain conditions.

Your copayment or coinsurance cost for HIV treatment depends on your individual plan. Each Part C plan sets its own cost and coverage amounts. Either way, you’ll still be responsible for your plan’s monthly premium.

Stand-alone prescription drug plans (PDP) pay for prescription medications that Original Medicare doesn’t cover. This means that Part D will not cover preventive emtricitabine/tenofovir disoproxil fumarate (Truvada).

However, Part D plans are required to cover emtricitabine/tenofovir disoproxil fumarate (Truvada) to treat HIV. Each plan sets its own cost and coverage amounts. Your deductible cannot exceed $590 in 2025.

After you meet your deductible, you’ll pay a copayment or coinsurance cost when you fill your prescription. These costs depend on your plan’s formulary and tier system.

The higher the tier, the more expensive the medication typically is. Generic emtricitabine/tenofovir disoproxil fumarate is a lower-tier medication and is usually less expensive than its brand-name counterpart.

Brand-name Truvada is generally considered a specialty drug and is among the most expensive medications at the highest tiers.

If you’re eligible for Extra Help in 2025, you’ll pay up to $4.90 for generic emtricitabine/tenofovir disoproxil fumarate and up to $12.15 for brand-name Truvada when you fill your prescription.

Emtricitabine/tenofovir disoproxil fumarate (Truvada) is a prescription drug used to prevent and treat HIV.

All Part B, Part C, and Part D plans cover the drug, but premiums, deductibles, copays, and coinsurance amounts vary from plan to plan.

Assistance programs are available that can help make the medication more affordable and easier to access. Check the company’s website for information on how to apply.