Paul Sanchez
Pre-exposure prophylaxis (PrEP) is a medicine that can help prevent HIV. It is available as a daily pill or a long-acting injection. PrEP is safe and effective, and it can reduce the risk of getting HIV from sex by about 99%. The cost of PrEP medication and services is usually covered by insurance, but if you don't have insurance, there are other programs that provide PrEP for free or at a reduced cost. To get started with PrEP, you need to be tested for HIV to ensure you don't have it, and to get other blood work done to make sure PrEP is safe for you.
| Characteristics | Values |
|---|---|
| Cost of PrEP without insurance | $2,000 for a one-month supply of Truvada |
| Cost of generic PrEP without insurance | Up to $60 per month |
| Cost of PrEP with insurance | Free under most health insurance plans and Medicaid |
| Co-pay assistance programs | Drug Manufacturers Co-payment Assistance Programs, State PrEP Assistance Programs, Co-payment Assistance Programs for Accessing PrEP via Telemedicine |
| Other expenses | Covered by Gilead or patient advocacy groups like the Patient Advocate Foundation |
| PrEP prescription requirements | HIV test, blood work, kidney function test, and other tests as needed |
| PrEP forms | Daily pill (Truvada, Descovy), bimonthly injectable (Apretude), long-acting injectable (every 2 months) |
| PrEP side effects | Nausea, loss of appetite, headaches, fever, muscle pain, rash, skin reactions at the injection site |
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What You'll Learn
The cost of PrEP without insurance
The cost of PrEP medication and services is typically covered by insurance. Under the Affordable Care Act, PrEP is free under almost all health insurance plans and is considered a preventive service. This means that there are no out-of-pocket costs for medication, clinic visits, or lab tests required to maintain your prescription.
However, if you do not have insurance or your insurance does not cover PrEP, the costs can be substantial. A one-month supply of Truvada, the most widely available PrEP drug, can cost nearly $2,000 without insurance, while the generic version can cost up to $60 per month. For a year's worth of medication, the cost can be between $22,000 and $30,000 out of pocket.
If you are unable to afford the cost of PrEP without insurance, there are several assistance programs available to help:
- Drug Manufacturers Co-payment Assistance Programs: These programs help lower or eliminate the amount owed as a deductible, co-insurance, or co-payment for PrEP medication.
- State PrEP Assistance Programs: States such as California, Colorado, Indiana, Massachusetts, New Mexico, New York, Oklahoma, Virginia, and Washington have programs to help cover the cost of medication, clinic visits, and lab testing for those without insurance or whose insurance does not cover PrEP.
- The federal government's Ready, Set, PrEP program: This program offers free medication to eligible participants.
- ViiVConnect: This program helps pay for PrEP shots.
- Medicaid: More than 90% of state Medicaid plans cover Descovy, another PrEP drug, without restrictions.
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State-based assistance programs
If you are considering taking PrEP medication, it is important to know that it must be taken as prescribed for it to be effective. While on PrEP, you will be tested regularly to ensure you are still HIV-negative.
PrEP medication can be costly, and a one-month supply of Truvada, the most widely available PrEP drug, costs nearly $2,000 without insurance. However, if you do not have insurance, there are state-based assistance programs that can help cover the costs of PrEP medication, clinic visits, and lab tests.
State PrEP Assistance Programs are available in California, Colorado, Indiana, Massachusetts, New Mexico, New York, Oklahoma, Virginia, and Washington. These programs help people who do not have insurance or whose insurance does not cover PrEP medication to access the medication they need at no cost. Additionally, Illinois, Iowa, and the District of Columbia have programs to lower or eliminate the amount owed as a co-payment for PrEP, as well as cover the costs of clinic visits and lab testing.
If you are a veteran who uses VA for healthcare, you may also be eligible to receive PrEP through Veterans Programs.
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Drug manufacturer co-payment assistance programs
If you don't have insurance or Medicaid coverage, there are resources that may help you pay for PrEP medication and/or your necessary clinic visits and tests. Drug manufacturer co-payment assistance programs are one such resource. These programs are sponsored by the pharmaceutical company that makes the medication and help people who have insurance to lower or eliminate the amount they owe as a deductible, co-insurance, and/or co-payment for a specific medication.
Each pharmaceutical company sets its own eligibility criteria for its programs. For example, for patient assistance programs, companies may set an income cap, whereas, for co-payment assistance programs, companies set a dollar cap. This means that once the company has provided a certain amount of support (e.g., $1,200 per year), you are responsible for paying the remaining deductible/co-insurance/co-payment to access the medication.
Some pharmaceutical companies that offer prescription assistance and co-payment assistance programs include:
- ViiVConnect
- Gilead Sciences (the manufacturer of Truvada and Descovy)
Additionally, if you are a veteran who uses VA for your healthcare, PrEP may be available to you.
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Other organisations that can help pay for PrEP
If you don't have health insurance, there are other programs that provide PrEP for free or at a reduced cost. Here are some organisations that can help pay for PrEP:
Drug Manufacturers' Patient Assistance Programs
These programs help people who don't have insurance or whose insurance does not cover PrEP to access the medication they need at no or low cost. Gilead, the company that makes oral PrEP, has a medication assistance program that could make PrEP free for you, depending on your income. Your doctor or nurse will need to submit an application for you to find out if you qualify.
State PrEP Assistance Programs
California, Colorado, Indiana, Massachusetts, New Mexico, New York, Oklahoma, Virginia, and Washington have state-based programs to help people who don't have insurance or whose insurance does not cover PrEP to access the medication they need at no cost. These programs also support the costs of clinic visits and lab testing.
Co-pay Assistance Programs
These programs help lower the costs of PrEP medications. Income is not a factor in eligibility. ViiVConnect offers a program to help pay for PrEP shots.
Veterans Programs
If you are eligible to receive care from Veterans Programs, PrEP is available for veterans who use VA for their healthcare.
Patient Advocate Foundation
The Patient Advocate Foundation helps people who have insurance to lower or eliminate the amount they owe as a co-payment for PrEP. They provide up to $7,500 per year to help pay for costs related to the prescription. Approval is based on your income.
Planned Parenthood
The staff at your nearest Planned Parenthood health center can help you apply for health insurance or assistance programs that can make PrEP affordable for you. They can also provide accurate, non-judgmental information about PrEP and help you get on PrEP if you want to.
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How to get a PrEP prescription
If you are considering taking PrEP medication, the first step is to consult a healthcare provider to determine if PrEP is suitable for you. To get started with PrEP, you will need to undergo an HIV test to ensure that you are HIV-negative, as well as other blood work to confirm that PrEP is safe for you.
PrEP is available through prescription by a licensed physician. There are two daily pill forms of PrEP, sold under the trade names Truvada and Descovy, and a bimonthly injectable form sold under the trade name Apretude. While on PrEP, you will need to get tested regularly before each new prescription or injection to ensure that you remain HIV-negative.
If you have health insurance, most plans, including state Medicaid programs, cover PrEP medication and services. Under the Affordable Care Act, PrEP is free under almost all health insurance plans, and you cannot be charged for your medication, clinic visits, or lab tests needed to maintain your prescription. If your insurance plan does not cover PrEP, you may be eligible for co-pay assistance programs that can help lower the costs of PrEP medication, clinic visits, and lab tests.
If you do not have health insurance, there are still options available to access PrEP medication. Some states have PrEP assistance programs that provide PrEP medication, clinic visits, or lab tests at no cost. Additionally, drug manufacturers' patient assistance programs offer medications at no or low cost for individuals without insurance or whose insurance does not cover PrEP.
Online services, such as Nurx, also provide PrEP prescriptions and free delivery. They can help you understand your insurance coverage and apply for payment assistance programs if needed.
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Frequently asked questions
If you don't have health insurance, you can still get help paying for PrEP. Gilead, the company that makes oral PrEP, has a medication assistance program that could make PrEP free for you, depending on your income. There are also co-pay assistance programs that help lower the costs of PrEP medications. Income is not a factor in eligibility. Some states have PrEP assistance programs that cover the costs of clinic visits and lab testing.
PrEP stands for pre-exposure prophylaxis. It is a medicine that can help prevent HIV. When taken as prescribed, PrEP can lower your chances of getting HIV from sex by up to 99%.
Anyone who is sexually active and doesn't have HIV can use PrEP. To find out if PrEP is right for you, talk to your nurse or doctor. You may choose to use PrEP if you have had anal or vaginal sex in the last 6 months, have been diagnosed with another STD within the last 6 months, have shared needles, syringes, or other equipment to inject drugs in the last 6 months, or have used PEP multiple times.
The most common side effects of PrEP are nausea, loss of appetite, headaches, fever, muscle pain, rash, and skin reactions where you got your shot. These side effects are not dangerous and they usually get better with time, once your body gets used to PrEP.
To get started on PrEP, talk to your healthcare provider or visit a sexual health clinic. You will need to get tested for HIV and other STIs to make sure PrEP is safe for you to take.
