In the U.S., more than 1 million people live with HIV, and nearly 40,000 new HIV cases are diagnosed every year.
Yet fewer than 10% of people who could benefit from the HIV-preventative medication PrEP–or “pre-exposure prophylaxis”–are taking it.
Curious about if PrEP is an option for you? Our pharmacists put together the 101 on everything you need to know.
What is PrEP?
PrEP is a daily pill that helps reduce the chances that an individual develops HIV by around 92%. It is prescribed for women, men, people of transgender experience, people of all gender identities and sexual orientations, youth, and people who inject drugs.
Right now, the CDC has approved two medications for use as PrEP: Truvada, which is intended for at-risk individuals through sex or injection drug use, and Descovy, which is intended for at-risk individuals through sex, except for people assigned female at birth who are at risk of getting HIV from vaginal sex.
Note that PrEP isn’t the same thing as PEP (post-exposure prophylaxis). PEP is a short-term treatment for people who’ve already been exposed to HIV within the past 72 hours. In contrast, PrEP is an ongoing, daily pill for people who may be exposed to HIV in the future.
Although PrEP is highly effective, it does not prevent STDs or STIs. People taking PrEP should still wear a condom, practice safe sex, and not share needles.
Who should take PrEP?
PrEP isn’t for everyone. You should consider PrEP if you:
- Worry about HIV
- Do not use condoms during sex with partners of unknown HIV status
- Recently had gonorrhea or syphilis
- Want to have sex without condoms with a partner who has HIV
- Exchange sex for money, food, housing, and/or drugs
- Inject drugs and/or share needles
How do you get a prescription?
One of the most challenging aspects for patients who wish to take PrEP can be finding a doctor who is knowledgeable and supportive. Organizations such as GLMA and Please PrEP Me have directories for finding friendly providers.
Once you find a doctor, they will ask questions about your sex practices and drug use (if any) to understand if it’s right for you.
You’ll also need to take several tests before PrEP is prescribed to you. First, you’ll take an HIV test to make sure you are negative. If your test returns positive, you’ll be connected to HIV care and treatment instead. You’ll also need to take an STI test, and get treatment if you are positive, as well as blood tests for viral hepatitis and kidney health.
What is the regimen for PrEP?
Once you’re confirmed as a candidate for PrEP, your doctor will write a prescription and explain how to take it. PrEP is taken once-a-day at the same time every day, with or without food.
It’s important to know that you will have regular follow-up meetings with your doctor every three months, during which additional tests are taken. This includes having blood drawn and peeing in a cup.
Possible effects–such as diarrhea, nausea, headache, and fatigue–are possible but typically go away with time.
How do you pay for PrEP?
For people who have health insurance, PrEP is often covered under their health insurance medication/pharmacy plan. If it is covered, the medication is likely either free or the cost of the patient’s co-pay.
Even for those who don’t have insurance, there are many options to get the medication at an affordable price. Within just the past month, multiple generic formulations of Truvada have become available in the U.S., leading to a drop in the cost. Now, online pharmacies such as Honeybee Health are able to sell PrEP for as little as $60 for a 30-day supply–without insurance and straight to your door.
Alternatively, Gilead (the maker of Truvada, the most popular version of PrEP) has a free co-pay assistance card that covers up-to $7200/year in out-of-pocket expenses for commercially insured individuals. Also, uninsured individuals under the 500% of federal poverty level can apply for the “Advancing Access” program from Gilead to have their costs covered.
PrEP is also overed for the uninsured on a federal level through https://www.getyourprep.com/. All Medicare C & D plans cover the cost of PrEP; that said, the plan may require cost-sharing, making the medication more expensive than the co-pay card or assistance.Prices also vary state-to-state. Some states have assistance programs that cover the cost of PrEP in full for qualifying individuals. These states include: California, Colorado, Washington D.C., Florida, Illinois, Indiana, Massachusetts, New York, Ohio, Virginia, and Washington. Overall, states and areas with high concentration of LGBTQ healthcare and public funding will typically have higher adherence to PrEP in comparison to communities that do not have existing funding. In metro areas such as San Francisco, New York, or LA, knowledge and adherence will be higher, and costs of medication and labs are typically covered. Areas with a larger concentration of LGBTQ minorities and transgender people typically see lower adherence and less education around PrEP.