Will Insurance Pay for PrEP?

Medical Insurance

Pre-exposure prophylaxis, or PrEP, is the most effective method for HIV prevention among individuals of high-risk populations. The drug Truvada has been on the market since 2012, and it is a powerful weapon in the fight against the spread of HIV – but it’s also not cheap, and its cost may dissuade some people from seeking treatment. Fortunately, if you are in this position, you may have some options.

Costs and Ways to Afford PrEP

To be effective, PrEP must be taken every day. It works by raising the level of antiretrovirals in your body, essentially killing any HIV infection before it has a chance to take hold of the body.

Because PrEP must be taken all the time, it can become quite expensive. This is especially true now, while the drug is still fairly new. At the moment, without insurance, the treatment can cost over $1,300 per month.

However, most insurance companies will cover the cost of Truvada. Because prevention is, in the long run, much more cost-effective for the insurer than covering the cost of lifelong HIV treatment, insurance is happy to pick up the tab for PrEP. In order to qualify, you will need a prescription from your doctor, who will also test you for HIV to ensure you are HIV-negative and a good candidate for PrEP. If you have insurance, you will need to pay the copay for prescription drug coverage, which will vary from one provider to the next; you can call your individual insurer to confirm this cost.

In addition, Medicaid covers PrEP. In New Mexico, if you are uninsured by other means and have a low income, you may qualify for Medicaid.

Affordability Programs

In addition to insurance and Medicaid, there are a few additional options that may be available to help with the cost of Truvada. There is a coupon card available to people who do not have prescription drug coverage, as well as medication assistance programs you may qualify to enroll in. You can learn more about these options here or talk with your doctor to find more available financial assistance.