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How Much Does PrEP Cost?

Man smiling who is taking PrEP for HIV standing in front of a mountain view.

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Medically reviewed by Katelyn Haggerty, FNP. Last updated 8/18/2021


What Is PrEP?

Truvada for PrEP (Pre-Exposure Prophylaxis), made by Gilead, is one of the drugs currently approved by FDA to prevent the Human Immunodeficiency Virus (HIV).

The pill is 99% effective in reducing the risk of getting HIV from sex when it is taken as prescribed, and 74% effective in reducing the risk of getting HIV for people who inject drugs.

Around 200,000 people use PrEP. In 2015 the CDC (The Centers for Disease Control and Prevention) estimated that there were 1.1 million people in the U.S who were taking advantage of using PrEP.As far as price is concerned, PrEP is not cheap. It may cost as little as $0 if you have insurance in place, to as high as $12,000 per annually (out of pocket).

Understanding Your Insurance

Navigating and finalizing your insurance plan is a complex task. The first thing you need to do is understand all the insurance plans and coverages. Then, figure out which coverage offers you the maximum benefits.

With the help of your doctor and Gilead Advancing Access program marshal, understand and work through the process of prior authorization, if requested. 

Prior authorization means your physician needs approval from your health insurance in order for PrEP to be covered.

Understand changes in your life or insurance that affect your coverage, such as:

  • Changes in insurance plan
  • If your coverage plan no longer covers treatment for HIV/AIDS
  • If the coverage or plan is denied
  • Any modifications in the insurance plan because of some unanticipated life event, like losing job

Now you can get the care you need from wherever you are—aka, your couch.


How Much Does PrEP Cost?

The cost of Truvada for PrEP treatment depends on the patient’s financial and insurance needs.

If you have consulted your doctor and they have prescribed Truvada for PrEP for you, then the Gilead Advancing Access program is committed to offer you affordable medication. 

For patients who are eligible for commercial insurance may pay as little as a $0 co-pay. However, whether you are insured, underinsured, and uninsured, Advancing Access may be able to help to you.

Some important points to be considered include:

  • Only people who are at an increased risk of HIV-1 infection and are at least 77 pounds in weight can benefit from Truvada for PrEP
  • You need to be HIV-negative in order to use Truvada for PrEP.
  • Truvada for PrEP is not helpful in preventing other STIs (sexually transmitted infections) or pregnancy.
14 Truvada for PrEP blue pills with a white background.

Cost of Truvada for PrEP With Insurance

Commercial Insurance

Gilead Advancing Access program (from manufacturers of Truvada – Gilead) gives a Co-payment coupon card to the people who qualify for this plan. 

This card offers co-payments for Truvada up to $7,200 per year and there is absolutely no monthly limit. 

That means $0 co-pay. For this benefit, there is no requirement of income eligibility. However, to be eligible for this plan, the patient must NOT be enrolled in Medicare or Medicaid insurance plans. 

For people under 18, a patient consultant or representative will be required to attest on the minor’s behalf.

Government Insurance

People enrolled in government healthcare programs like Medicaid, Medicare Part D, VA or Tricare are not eligible for benefits from the Gilead Advancing Access program.

No Prescription Drug Insurance Coverage

National Programs like “Ready, Set, PrEP” offer PrEP medication available at no cost to people without prescription drug insurance coverage. To qualify, patients must:

  • Test HIV negative
  • Lack prescription drug coverage
  • Have a prescription for PrEP
  • Have no current or prior enrollment in the Gilead Advancing Access Patient Assistance Program within the previous 12 months
Man wearing glasses and a blue shirt standing in front of a blue wall, who is on the medication PrEP.

Without Insurance 

Gilead Advancing Access (Plan by Gilead) can help you determine if you are eligible for this program, or help you figure out alternative insurance options.

With no insurance, Truvada for PrEP medication is offered at zero cost to people who are eligible for the Medication Assistance Program.

Medicaid or Medicare 

Medicaid

This program is a U.S. federal insurance plan that offers free treatment for Truvada for PrEP. However, the recipient needs to be a citizen of America.

The biggest challenge in the case of Medicaid, is that many low-income people who would benefit from PrEP are not eligible for Medicaid, because they are not disabled, pregnant, or single parents of eligible children. 

Also, some Medicaid plans have complex systems for the process of prior authorization, or restrict the number of medicines each month available to the recipient or the beneficiary.

This plan offers benefits in terms of prescription costs, lab tests, diagnosis, and medical appointments. However, prior approval is required and renewed every 3 months.

Medicare Pays for PrEP

Medicare is a federal health insurance (in the U.S) for those who are at least 65 years of age, or who qualify for lifelong physical disabilities. 

This federal health insurance is delivered by private coverages or insurance plans.

Medicare is a federal health insurance (in the U.S) for those who are at least 65 years of age, or who qualify for life long physical disabilities. This federal health insurance is delivered by private coverages or insurance plans.

A Medicare rule states that 6 classes of drugs, including HIV drugs, must be included, in the Medicare prescriptible medicines.

However, coverage may have some variations when it is delivered by private plans.

Close up photo of $100 U.S. dollar.

How to Get PrEP

]Look for your nearest health center and identify your healthcare provider. Click here to use a PrEP Locator to find resources in your area.

  • Make sure that you tell your doctor if you have any medical conditions associated with your liver, kidney, bone, or if you have hepatitis.
  • In case you plan to conceive or have already conceived. Experts do not know if Truvada for PrEP can be harmful to your unborn child. Consult your doctor if you become pregnant while using Truvada for PrEP.
  • Truvada for PrEP may interact with other medications if you are taking supplements, vitamins, or herbal medication. It is important to always consult your doctor and pharmacist whenever you get a new medication.
  • In case you experience several side effects of Truvada, report it to the FDA.
  • If you take certain other medications with Truvada, your doctor may need to check you more often or change your dosage of Truvada. These drugs are inclusive of certain medicines that are helpful in treating Hep B (Hepatitis B) or Hep C (Hepatitis C) infection.

Now you can get the care you need from wherever you are—aka, your couch.


Cost of PrEP

PrEP is not cheap, if you do not have your insurance in place. The out-of-pocket costs can be high.

However, many insurance plans like Gilead’s prescription assistance programs, Medicaid, and Medicare, are available that offer Truvada for PrEP at a minimal or no cost.

If you are eligible for subsidised PrEP through your insurance plan, you will only pay the copayment amount. 

Gilead – the makers of Truvada, can assist you in determining which insurance plan will give you maximum benefits through Gilead Advancing Access.

Protection from diseases like HIV/AIDS is very important. 

For easy and affordable access to this medication, it is best to have a suitable insurance plan in place.

References

PrEP Facts. The Questions About PrEP. Accessed March 15, 2020 at https://prepfacts.org/prep/the-questions/ .

Planned Parenthood. What is PrEP. Accessed March 15, 2020 at https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids/prep.

HIV.gov. The Affordable Care Act and HIV/AIDS. Accessed March 15, 2020 at https://www.hiv.gov/federal-response/policies-issues/the-affordable-care-act-and-hiv-aids.

CNBC. Free daily HIV prevention pills will soon be available to private insurance holders. Accessed March 15, 2020 at https://www.cnbc.com/2019/06/11/private-insurers-must-cover-prep-at-no-cost-to-high-risk-patients.htmlF.

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