Paul Sanchez
Pre-exposure prophylaxis (PrEP) is a medication that reduces the risk of HIV infection. The cost of PrEP medication varies depending on insurance coverage and access to financial assistance programs. Without insurance, PrEP medication is expensive, with a 30-day supply of Truvada, the most common form of PrEP, costing around $2,000. However, under the Affordable Care Act, PrEP is free under almost all health insurance plans and there are also state and manufacturer assistance programs that can help cover the costs.
| Characteristics | Values |
|---|---|
| Cost without insurance | $2,000-$3,000 per month |
| Cost with insurance | $0 out-of-pocket with most private health insurance plans |
| Cost with Medicare | Covered |
| Cost with Medicaid | Covered |
| Cost with military insurance | Covered for those with income at or below 500% of the current federal poverty level |
| Cost with Veterans Programs | Covered |
| Cost with state-based programs | Covered in California, Colorado, District of Columbia, Illinois, Indiana, Iowa, Massachusetts, New Mexico, Oklahoma, Virginia, and Washington |
| Cost with Advancing Access program | $0 per month with coverage of up to $7,200 a year for copays |
| Cost with generic Truvada | $60 per month |
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What You'll Learn
- PrEP is free with most health insurance plans
- Without insurance, PrEP medication can cost up to $2,000 per month
- Generic Truvada is a more affordable alternative to Truvada
- State PrEP Assistance Programs in certain states help cover costs
- The Advancing Access program offers savings on Truvada for commercial insurance holders
PrEP is free with most health insurance plans
PrEP medication is free with most health insurance plans. Under the Affordable Care Act, PrEP is free under almost all health insurance plans. This is because PrEP is a preventive service and should be covered without charging a co-payment or co-insurance. This applies to most private health insurance plans, individual plans purchased through HealthCare.gov or state-based marketplaces, and state Medicaid expansion coverage plans, including the Basic Health Plans.
The cost of PrEP medication without insurance can be very expensive, with a 30-day supply of Truvada costing around $2,000, and a year's worth of medication costing between $22,000 and $30,000. However, there are ways to save money on PrEP medication, such as using a GoodRx coupon, which can reduce the cost of a 30-day supply of generic Truvada to less than $30. Additionally, the Advancing Access program offers people with commercial health insurance the opportunity to save on Truvada for PrEP, with coverage of up to $7,200 a year for copays if you qualify.
If you do not have insurance, there are resources that may be able to help you pay for PrEP, such as the Ready, Set, PrEP program, which provides access to free daily oral PrEP medication. Additionally, there are state-based programs in California, Colorado, Indiana, Massachusetts, New Mexico, New York, Oklahoma, Virginia, and Washington that help people who do not have insurance to access the medication they need at no cost.
It is important to note that PrEP must be taken consistently for at least seven days to 20 days to be effective in preventing HIV transmission, and it is significantly more effective when taken every day.
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Without insurance, PrEP medication can cost up to $2,000 per month
The cost of PrEP medication varies depending on the type of insurance coverage and access to financial assistance programs. Without insurance, PrEP medication can cost up to $2,000 per month, which amounts to $22,000 to $30,000 per year. This high cost makes it unaffordable for many people, especially those without insurance.
However, it is important to note that PrEP medication is considered preventive care, and under the Affordable Care Act (ACA), most health insurance plans are required to cover it at no cost to the patient. This includes private health insurance plans, individual plans purchased through HealthCare.gov or state-based marketplaces, and state Medicaid expansion coverage plans. In some states, traditional Medicaid programs also cover PrEP at no charge.
For those with private insurance that doesn't cover PrEP or requires a co-payment, there are co-pay assistance programs available. These programs help lower or eliminate the amount owed as a deductible, co-insurance, or co-payment for PrEP medication. Additionally, some states have their own PrEP assistance programs that provide medication at no cost for those without insurance or whose insurance doesn't cover PrEP.
To further reduce costs, generic versions of PrEP medication, such as generic Truvada, are available at a fraction of the cost of brand-name options. These generic versions have the same active ingredients and are highly effective in preventing HIV, making them a more affordable alternative.
For those who struggle with the cost of PrEP medication, there are various resources and programs available to provide assistance and help make PrEP more accessible and affordable.
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Generic Truvada is a more affordable alternative to Truvada
Pre-exposure prophylaxis (PrEP) is a medication that helps reduce the risk of HIV infection. While PrEP medication is often covered by insurance, there are cases where people with private insurance face billing issues or coverage obstacles. In these cases, a more affordable alternative to Truvada is its generic version, emtricitabine/tenofovir.
A 30-day supply of Truvada without insurance costs around $2,000, whereas its generic version costs about $60 for the same period. This is a significant difference in price, making the generic version a more cost-effective option for those who may struggle to afford Truvada.
GoodRx is one option for those looking to save on PrEP medication. They offer coupons that can help reduce the cost of a 30-day supply of the generic version to less than $30, resulting in a 99% savings compared to the average retail price of generic Truvada. Additionally, the Advancing Access program offers savings on Truvada for those with commercial health insurance. With a Truvada coupon card, one may pay as little as $0 per month, with coverage of up to $7,200 a year for copays if eligible.
For those without insurance, there are still options to access PrEP medication. The U.S. government's Ready, Set, PrEP program provides free daily oral PrEP medication to those who qualify. Additionally, drug manufacturer patient assistance programs help people without insurance or whose insurance does not cover a specific medication to access the medications they need at low or no cost. State PrEP assistance programs in California, Colorado, Indiana, New Mexico, Oklahoma, Virginia, and Washington also help people without insurance or with insufficient coverage to access PrEP medication at no cost. Massachusetts and New York are also listed in one source.
While Cimduo is another alternative to Truvada, it is not FDA-approved as an equivalent for PrEP. It is also not technically a generic drug, and at 40% lower than Truvada's price, it may not be considered a low-cost option.
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State PrEP Assistance Programs in certain states help cover costs
The cost of PrEP medication is typically covered by insurance. Under the Affordable Care Act, PrEP medication should be free under almost all health insurance plans as it is considered preventive care. However, people with private insurance often face billing issues or coverage obstacles for the medication.
- California
- Colorado
- Indiana
- Massachusetts
- New Mexico
- New York
- Oklahoma
- Virginia
- Washington
These programs help lower or eliminate the amount owed as a co-payment for PrEP. They also support the costs of clinic visits and lab testing.
Additionally, the Advancing Access program offers people with commercial health insurance the opportunity to save on Truvada for PrEP. With a Truvada coupon card, one may pay as little as $0 per month, with coverage of up to $7,200 a year for co-pays if they qualify.
If you are eligible to receive care from Veterans Programs, PrEP is available for veterans who use VA for their healthcare.
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The Advancing Access program offers savings on Truvada for commercial insurance holders
Pre-exposure prophylaxis (PrEP) medication is highly effective in preventing HIV infection. Truvada is a type of PrEP medication that can reduce the risk of getting HIV from sex by about 99% and from injecting drugs by about 74%. While Truvada can be very expensive without insurance, the Advancing Access program offers savings for people with commercial health insurance.
The Advancing Access program is offered by Gilead Sciences, the manufacturer of Truvada. The program provides co-pay support for eligible people on HIV treatment and HIV prevention medication with commercial insurance who need help paying for their out-of-pocket medicine costs. This includes people on Truvada for PrEP. With the Advancing Access program, eligible patients can pay as little as $0 per month, with coverage of up to $7,200 a year for copays.
To be eligible for the Advancing Access program, you must have commercial insurance and need help paying for your out-of-pocket medicine costs. The program is not available for people enrolled in government healthcare prescription drug programs, such as Medicare and Medicaid. Additional restrictions may apply, and you can learn more by calling the Advancing Access program specialist line at 1-800-226-2056.
In addition to the Advancing Access program, there are other ways to save on Truvada for PrEP. If Truvada is not on your health plan's formulary (list of covered drugs), you can work with your healthcare provider to file an appeal. You can also consider Truvada's generic option, which can cost as little as $30 for a 30-day supply with a GoodRx coupon. Additionally, if you qualify, you can receive PrEP medication for free from the U.S. government through the Ready, Set, PrEP program.
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Frequently asked questions
The cost of PrEP medication with insurance depends on the insurance provider and the type of PrEP medication. Most private health insurance plans cover the cost of PrEP medication, with some reporting that 94% of the cost is covered. However, some insurance providers may only cover the cost of generic PrEP medication, which is the most commonly prescribed version and usually the most affordable.
The cost of PrEP medication without insurance can be very expensive, with a month's supply of Truvada costing nearly $2,000. The generic version of Truvada is significantly cheaper, costing approximately $60 for a month's supply. For a year's worth of medication without insurance, the cost could be between $22,000 and $30,000.
If you cannot afford PrEP medication, there are several assistance programs available that can help cover the cost. These include state-based programs in California, Colorado, Indiana, Massachusetts, New Mexico, New York, Oklahoma, Virginia, and Washington, which help people who do not have insurance or whose insurance does not cover PrEP medication to access it at no cost. Additionally, the U.S. government's Ready, Set, PrEP program provides free daily oral PrEP medication to those who qualify.
