PrEP is great. When you take it as prescribed, it reduces your chances of catching HIV by 99%. But, if you have to pay the full retail price, it’s over $2,000 per month. Nobody can afford that. Luckily, you don’t have to. 

PrEP is great. When you take it as prescribed, it reduces your chances of catching HIV by 99%. But, if you have to pay the full retail price, it’s over $2,000 per month. Nobody can afford that. Luckily, you don’t have to. 
What’s PrEP? 

PrEP stands for “Pre-Exposure Prophylaxis.” It’s a medicine that HIV-negative people can take before being exposed (pre-exposure) to the virus to prevent (prophylaxis) them from getting HIV.  

Your doctor or nurse practitioner will write you a prescription for one of two medicines: Truvada or Descovy. They are both made by the same company, Gilead. 

Before we get into the money-stuff, remember this: PrEP only prevents HIV-negative people from contracting HIV. It does not protect against other sexually transmitted infections (STIs) like syphilis, gonorrhea, or HPV. It also does not prevent pregnancy. So, you still need to consider other ways of protecting yourself during sex to stay healthy.  

Get in on the plan

Getting PrEP for free means that you’ll need to learn about your insurance coverage, commercial support, and non-profit funding.  Below, we’ll walk through what’s out there.

Private Health Insurance 

You’ve got private health insurance if you get your coverage through your job. You also probably have private health insurance if you get it through your parent’s or spouse’s work.  Finally, if you purchase your plan on the health insurance marketplace, you’ve got private health insurance. That’s good news! Your insurance most likely covers Truvada and Descovy.  

Most private insurance plans have out-of-pocket costs. They are called co-pays, co-insurance, and deductibles. These are expenses that you have to pay on top of your policy premium (the monthly charge for your health insurance). These can really add up. But don’t worry, there’s help out there. 

To find out about your co-pays, co-insurance, and deductibles, look at your insurance card. It usually has all of this information. To find out if your plan covers Truvada or Descovy, call the number on your card. You can also ask your boss or company HR people for the number to call if you can’t find your card.   

Co-Pay Cards 

For folks with private health insurance, this is pay dirt. Gilead, the company that makes Truvada and Descovy, has a program that will help you pay up to $7,200 per year for PrEP. That’s $600 per month.  This program has no income guidelines and is available to almost everyone with private insurance.

Medicaid

Medicaid is a federal, public health insurance program that each state runs. In Ohio, you can qualify for Medicaid if you are:   

• an individual with a low income (around $1,660 per month or less for an individual Ohio resident)
• are a person who’s pregnant, a child, or an infant
• an older adult
• or a person living with a disability

Signing up for Medicaid involves some paperwork. If you think you qualify but are unsure of how to get going, there are plenty of folks who can help you through the process.

What if I don’t have insurance?

Sadly, some folks make too much money to qualify for Medicaid but don’t get insurance through their job and can’t afford a marketplace plan. Don’t worry. There are Patient Assistance Programs through the drug manufacturer, Gilead. These programs help cover the cost of the medicines for uninsured, lower-income individuals.  

Ohio’s PAPI 

Patient Assistant Program Intervention (PAPI) is a program of the Ohio Department of Health. PAPI helps Ohioans with lower incomes (less than 500% of the Federal Poverty Limit – which is around $62,450 per year in 2020) who are HIV negative pay for coverage, treatment, and follow-up care. 

Good Days 

Good Days is a non-profit that helps people with lower incomes (less than 500% of the Federal Poverty Limit) who have some insurance. They help by providing up to $7,500 per year for medicine. Truvada and Descovy are both covered by Good Days.

That income thing 

Income is a big part of some programs. They want to make sure that they’re helping people who need help. You may want to look at last year’s tax return or a recent paycheck to figure this out. The income number that these programs use is your pre-tax (gross) income. They don’t use your take-home pay. 

Get a game plan 

When you know what kind of insurance you have, your deductible and co-pay amounts, and income, you’re ready to put your plan together.  When you know what kind of insurance you have, your deductible and co-pay amounts, and income, you’re ready to put your plan together.  In your plan, you need to include the price of the medicines along with the costs of other required services. When you get on PrEP, it means getting some bloodwork every few months and follow-up appointments every once in a while. Co-pays, co-insurance, and deductibles may apply. For uninsured folks, these may have a cost, as well.

PrEP navigators are here for everybody who’s looking to get on and stay on PrEP. You don’t need to be a patient of MetroHealth or University Hospitals for them to help you. You just need to be you.