PrEP Payment Options
|Type||Coverage or Services||Eligibility||Contacts|
Most plans cover PrEP
Coverage varies based on plan, and there may be deductibles and co-payments
|Medicaid||PrEP prescription costs, medical appointments, and lab tests||Prior approval that must be renewed every 3 months||
HELPLINE: (800) 541-2831
|PrEP Assistance Program (PrEP-AP)||
Doctors’ visits and lab tests
HIV and STI/STD testing, counseling, and supportive primary care services consistent with PrEP clinical guidelines
PrEP medications obtained through manufacturer patient assistance programs
There is no age limitation, but to be eligible, a patient must be: 1) Not HIV-infected; 2) At risk acquiring of HIV; 3) A resident of New York State; 4) Uninsured or under-insured; 5) At 435% of the Federal Poverty Level (FPL) or lower with annual income
To be eligible, providers must be: 1) Enrolled in the New York State Medicaid Program; and 2) Responsible for assisting patients with the PAP application to receive Truvada as indicated for PrEP
HOTLINE: (800) 542-2437
ADAP Provider Relations: (518) 459-1641 or e-mail
|Gilead Co-Pay Coupon Card||Up to $300/month in prescription co-payments||To be eligible, patients must: 1) Be 18 years of age or older; 2) Have private insurance; 3) NOT be enrolled in Medicare or Medicaid||
Phone: (877) 505-6986
|Gilead Truvada for PrEP Medication Assistance Program||Prescription costs||To be eligible, patients must: 1) Be uninsured or have no insurance coverage for prescription medications; 2) Have an annual income less than 500% of FPL||
Phone: (855) 330-5479
|Patient Advocate Foundation for Co-Pay Relief||
Grants of up to $7,500 per year for assistance with co-payments, co-insurance, and deductibles
There is no age limitation, but to be eligible, patients must: 1) Have insurance and coverage for prescription medications; 2) Have an annual income less than 400% of FPL
Phone: (866) 512-3861
Applications may be submitted online or by by phone: (866) 512-3861, M-F 8:30 AM to 5:30 PM, EST, by patients or by their medical care provider or pharmacist
Helps uninsured Americans get prescription medications at no or low cost
|Visit the website, enter drug names, and answer a few questions to learn of available options||
Phone: (888) 477-2669
|Gilead Advancing Access||
Matches patients to a Gilead assistance program based on eligibility criteria
Phone: (800) 226-2056 Counselors are available M-F,
More information on PrEP payment options is available from the New York Department of Health
Consumer Q/A: PrEP to Help Prevent HIV
Updated October 2017
This Q/A fact sheet covers the topics in the New York State Department of Health guideline on starting pre-exposure prophylaxis (PrEP). The goal is to help people talk with their care providers about PrEP.
About the Guideline
What is the purpose of the guideline? The guideline is a set of recommendations for care providers. It explains who should take PrEP and why, when PrEP should be started, and other important issues about PrEP use.
Who wrote the guideline? The guideline was written and reviewed by a group of care providers in New York who specialize in preventing the spread of HIV. The recommendations are based on research studies and the doctors’ experience treating people at risk for HIV.
What is PrEP?
What is PrEP? “PrEP” is short for “pre-exposure prophylaxis,” which is a term used to describe the use of antiretroviral (ARV) medications to decrease your risk of getting HIV. When used as prescribed, PrEP has been shown to effectively prevent HIV transmission in men who have sex with men, in people who inject drugs, and in men and women who have sex with opposite-sex partners.
How does PrEP prevent the spread of HIV? When taken as prescribed, the medications in PrEP prevent HIV from multiplying in the body.
Are PrEP medications the same as HIV drugs? No. PrEP contains two ARV medications, tenofovir disoproxil fumarate and emtricitabine (or TDF/FTC; the brand name is Truvada). These medications are also used to treat HIV, but when used for treatment, require at least one additional medication to be strong enough against HIV infection.
–> Learn more about: Antiretroviral Therapy
What are the PrEP drugs and how do I take them? Truvada is a single pill that combines two ARVs: emtricitabine/tenofovir disoproxil fumarate or TDF/FTC. The pill is taken once a day, even on the days that you don’t have sex, inject drugs, or have other risk factors for HIV.
Researchers are working on finding other drugs for PrEP and other ways to provide PrEP, such as long-acting injections.
Are PEP and PrEP the same thing? PEP, or post-exposure prophylaxis, is medication taken for 28 days after a possible exposure to HIV. PrEP is taken before any possible exposure to HIV.
People who think they might be at risk for exposure to HIV again, after finishing PEP, may be encouraged to start PrEP .
–> Learn more about: PEP
Who Should Use PrEP?
Who is PrEP for? Is PrEP right for me? Anyone who does not have HIV infection, including adolescents, can take PrEP if they may be at risk of HIV infection.
PrEP is especially important for those at the highest risk of being exposed to HIV, such as:
- Men who have any amount of sex with other men without always using condoms
- Transgender women who engage in any amount of sex without condoms
- People who inject drugs and share equipment with others
- Couples in which one partner has HIV infection and the other doesn’t (known as “serodiscordant” couples) who have sex without condoms
- Serodiscordant couples who are trying to conceive a child
- Anyone who has taken ARVs as PEP after a possible HIV exposure from sex or drug use
Are there any health conditions that prohibit use of PrEP? PrEP is not safe for people with poor kidney function.
And if you have chronic hepatitis B virus infection, your care provider will have to monitor your use of PrEP.
How should I talk with my care provider about PrEP? Tell your care provider that you are interested in PrEP and would like to talk about whether it is right for you. Even if you don’t want to disclose how you may be exposed to HIV, your care provider can and should prescribe PrEP if you ask for it.
–> Learn more about: People who should take PrEP
Why should I take a pill every day if I don’t have HIV? PrEP is a safe and effective way to protect yourself from getting HIV. It is not always possible to know whether a sex or drug use partner has HIV or has an undetectable viral load, so it’s better to always protect yourself.
Do I need any tests before I start PrEP? You have to have an HIV test to make sure you do not have HIV infection. There are a number of other laboratory (blood) tests that your care provider may order if you have not already had these tests recently. These tests are to make sure your kidneys are functioning well and to screen for other infections commonly spread through unprotected sex or shared drug use equipment.
How often do I have to see my care provider once I start taking PrEP? People who take PrEP should be tested for HIV infection every 3 months. At those 3-month time points, your care provider will also screen for other sexually transmitted infections (STIs) like syphilis and gonorrhea.
You should contact your care provider and get tested for HIV right away if you have any symptoms that might be from acute HIV infection, like a flu-like illness with fever, headache, body aches, or rash.
How much does PrEP cost? Truvada, the PrEP drug, costs between $8,000 and $14,000 per year, in addition to the costs of four medical checkups annually and necessary lab tests. Medicaid and most private health insurance covers PrEP.
–> Learn more about: Getting PrEP in New York
Is it safe to take PrEP with other medications, alcohol, or recreational drugs? Many medicines, including PrEP, can interact with other medicines, nutritional supplements, or even vitamins. Talk to your care provider or pharmacist before you use any type of new medicine or health supplement.
PrEP and Protection From HIV and STIs
How effective is PrEP at preventing HIV? Studies have shown that people who took daily PrEP were much less likely to get HIV than those who were not taking it daily. PrEP reduced the risk of getting HIV from sex by more than 90%. In people who inject drugs, daily PrEP reduced the risk of getting HIV by more than 70%.
–> Learn more about: CDC’s clinical studies of PrEP
Will PrEP protect me from STIs other than HIV? PrEP will not protect you from STIs other than HIV. Condoms are still the best method of protection against other STIs.
Does PrEP provide protection as soon as a person starts taking it? NO. It takes some time to build up enough PrEP in your blood to protect against HIV infection.
What happens if I stop taking PrEP and then start taking it again later? You should do your best to take PrEP every day. There is not enough research about inconsistent PrEP use to say how many doses of PrEP can be safely be missed. Adherence is essential with PrEP.
Side Effects and Long-Term Effects
Will PrEP cause side effects? Most people experience no side effects from PrEP. Some may have temporary nausea, vomiting, diarrhea, headache, and or a general feeling of being unwell or sick.
If you experience side effects, get in touch with your care provider. He or she may have tips to help you reduce the symptoms and make PrEP easier for you to take. Do not stop taking PrEP or change the way you take it without consulting your care provider.
–> Learn more about: PrEP side effects
What are the long-term effects of taking PrEP? No negative long-term effects have been reported by people who have used PrEP for up to 3 years. In very rare cases, PrEP can cause kidney or bone problems. Your care provider will do tests to monitor for these problems while you are on PrEP.
HIV Infection While on PrEP
How often should I get tested for HIV after I start PrEP? You should be tested for HIV one week before starting PrEP and then every 3 months afterward.
You should be tested for HIV immediately if you have any symptoms that might be from acute HIV infection, like a flu-like illness with fever, headache, body aches, or rash. If you experience that kind of illness, then you should contact your care provider immediately.
What happens if I get infected with HIV while I’m on PrEP? If you test positive for HIV infection while on PrEP, your care provider will help make sure you are connected to proper HIV care. This will include stopping your PrEP, testing to confirm the diagnosis of HIV, and prescribing an appropriate ART regimen.
If I get infected with HIV while on PrEP, will it be drug-resistant? Not necessarily, but continuing to take PrEP after HIV infection increases this risk because the drug levels in PrEP are not strong enough to treat HIV. This is why regular HIV testing is important even while taking PrEP.
–> Learn more about: HIV Drug resistance
If I start PrEP, do I have to take it for the rest of my life? No. How long you take PrEP depends on the length of time that you are at risk for HIV. For example, if you stop injecting drugs, and that is your only risk, then you may be able to stop taking PrEP. If you establish a monogamous relationship with someone who does not have HIV infection, you may wish to stop PrEP. Ongoing, open conversation with your care provider can help with the decision to continue or stop PrEP.
Do I have to take PrEP every day? Yes. Protection with PrEP requires that you take it every day (complete adherence). If you miss doses, then you may lose protection. Alternative methods of HIV prevention, like condoms, may be best for those who cannot commit to a daily pill or who can’t do regular HIV testing.
What happens if I miss a dose of my PrEP drugs? If you miss doses of PrEP, then you should be sure to use condoms for sex and to avoid sharing drug use equipment. Missed doses may reduce the level of drug in your blood to a level too low to protect you from getting HIV infection.
What is “adherence” and why is it important? Taking medications the way they are prescribed (how often, time of day, and with or without food) is called “adherence.”
It is important to take PrEP drugs on a regular schedule because missing doses can reduce the level of protective drug in your blood and increase the risk of HIV infection. Taking the drugs as prescribed will make sure the proper amount of medicine is absorbed by your body.
–> Learn more about: Adherence
Condom Use with PrEP
Do I still have to use condoms if I’m taking PrEP? It’s a good idea to use condoms. PrEP does not prevent pregnancy or protect you from other STIs, such as syphilis.
–> Learn more about: HIV and STI prevention strategies
Do I still have to take PrEP if I always use condoms? Regular condom use is an excellent way of taking control of your sexual health and reducing your risk for HIV. PrEP is available as an additional tool for HIV prevention for those who are still worried about HIV risk.
Online Resources for Education, Information, and Services
AIDS.gov: Pre-Exposure Prophylaxis (PrEP)
Centers for Disease Control and Prevention (CDC)
New York State Department of Health (NYSDOH)
University of California San Francisco (UCSF): PrEP for U.S. Trans Women
E-patients.net: Salzburg Statement on Shared Decision Making
HIV Clinical Resource: Payment Options for PrEP