PrEP (pre-exposure prophylaxis) is a medication that the FDA has approved since 2012 for HIV prevention. PrEP is a preventative measure and must be taken before a person is exposed to HIV. In the USA, Descovy has also been approved for use as PrEP. Generic forms of PrEP are available, which contain the same active drugs as Truvada and Descovy. It does not stop the progression of HIV to AIDS, and it is not a treatment for HIV. A prescription for PrEP can cost up to $21,000 annually.
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The Cost of PrEP Costs without Insurance
There are currently two medications for PrEP: Truvada and Descovy. Truvada is approved for PrEP for adult and adolescent cisgender and transgender males and cisgender and transgender females. Descovy was approved for PrEP in 2015, but it is only available for cis-gender males and transgender females currently.
A prescription for PrEP can add up to over $21,000 annually – as it costs $1,758.00 for a thirty-day supply if purchased without insurance or other payment programs.
Assistance Programs for PrEP
There are various assistance programs you can take advantage of to cover the costs of PrEP.
Advancing Access Medication Assistance Programs
Who sponsors it: Gilead, the maker of Truvada
What it covers: Out-of-pocket costs for Truvada, up to $7,200 per year. It doesn't cover the costs of doctor visits or lab tests.
Ready, Set, PrEP
Who sponsors it: The U.S. Department of Health & Human Services and Gilead, which donates 2.4 million bottles of Truvada and Descovy to the program each year
What it covers: The cost of Truvada
Who is eligible: People who don't have prescription drug coverage, have tested negative for HIV, and have a prescription for Truvada
Co-Pay Relief Program
Who sponsors it: The Patient Advocate Foundation, a nonprofit organization that helps people with chronic or life-threatening diseases
What it covers: Out-of-pocket costs for Truvada, up to $7,500 per year. It doesn't cover the costs of doctor visits or lab tests.
Who is eligible: People who don't have health insurance or whose insurance plan covers Truvada. Your income must be below 400% of the current federal poverty level.
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Who sponsors it: Good Days, a nonprofit organization that offers resources for people who don't have access to health care
What it covers: Out-of-pocket costs for Truvada, up to $7,500 per year
A few states have their own drug assistance programs that cover out-of-pocket expenses for PrEP. Some will also cover the costs of doctor visits and lab tests. Requirements to qualify for these programs differ by state.
States with PrEP assistance programs are:
- District of Columbia
- New York state
- Washington state
To learn about these programs, contact your state's department of public health.
PrEP Frequently Asked Questions (FAQs)
Below we outline frequently asked questions about PrEP.
How does PrEP work?
The medications in PrEP prevent HIV from spreading within the body; however, if you do not take PrEP daily, there may not be enough medication in your bloodstream to work properly. Truvada, the brand name for PrEP, contains two active medications: tenofovir and emtricitabine.
These medications temporarily occupy the body's T cells, which are part of the adaptive immune system. HIV attacks human T cells, so if there is enough PrEP in the body at the time of infection, the spread of HIV can be stopped from establishing a permanent infection.
Who is PrEP for?
PrEP may be a good option for you if:
You have had anal or vaginal sex in the past 6 months, and you
- have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load),
- have not consistently used a condom, or
- have been diagnosed with an STD in the past 6 months,
You inject drugs, and you
- have an injection partner with HIV, or
- share needles, syringes, or other equipment to inject drugs (for example, cookers).
You have been prescribed PEP (post-exposure prophylaxis), and you
- Report continued risk behavior, or
- Have used multiple courses of PEP.
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Is PrEP effective?
When taken correctly (once per day), PrEP is very effective at preventing HIV. Some studies demonstrate that PrEP reduces the risk of getting HIV from sex by 99% when taken daily. It is important to note that PrEP does not protect against other STDs and only protects against HIV.
How can I get PrEP with private insurance?
Although it is not certain that every private insurance plan will cover PrEP, prepfacts.org indicates that there are currently no reports of people having trouble getting coverage for this medication.
The cost of PrEP will vary depending on your plan but should be consistent with your co-pay for other prescription medications. If your co-pay is too high, some programs can help cover these costs.
Do I need a prescription for PrEP?
Yes, you need a prescription to get PrEP. It is strongly recommended that you not share a prescription for PrEP with friends or family. It is essential that a doctor evaluates your current medications and medical history and develops a personalized HIV prevention plan for you.
Does Medicaid cover PrEP?
Medicaid covers PrEP in states like New York and Florida, but actual Medicaid coverage varies from state to state, so check with your benefits counselor. It is in the hands of Public policy advocates as they will have to ensure. PrEP is accessible to everyone in the coming months and years.
My PrEP Experience monitors the insurance and Medicaid coverage of Truvada for PrEP. If you have trouble getting a prescription for Truvada as PrEP or getting a PrEP prescription covered by insurance, Medicaid, or Gilead, you can email [email protected]
How do I ask my doctor about PrEP and set up a plan?
Although talking about the need for PrEP with a health care provider can be difficult, it can ultimately help you practice safer sex and reduce your risk of contracting HIV. Before seeing your doctor, do some research on PrEP and put together a list of your current medications and past medical history.
During your visit, you can tell your doctor that you are interested in exploring if PrEP would be a good fit for you. You must be honest and transparent with your doctor regarding your current behavior and history that may put you at an elevated risk for HIV. This will help your doctor make the best decision regarding a specific HIV prevention plan for you.
If your doctor decides it is best to prescribe PrEP, they may want to see you more regularly to monitor your health and any side effects. Most doctors will likely want to see their patients every two or three months. Additionally, there may be a need for increased HIV testing.
The Bottom Line
PrEP is an effective medication for preventing HIV. However, the cost can be a barrier when accessing the medication. It's important to utilize assistance programs while paying for PrEP to save money.
Tim Horn is a director of the Health Care Access team and oversees NASTAD (National Alliance of State & Territorial AIDS Directors) medication access and pricing portfolio. He works across teams to ensure fair pricing and equitable access to drugs and biologics critical to the prevention and care needs of people living with and vulnerable to HIV and hepatitis C virus (HCV). Horn was interviewed to gain further insight on the access of PrEP.