How can I get PrEP without insurance?

Illustration: Marc Bruxelle

@AskPeaches: I’m gay, in my twenties and work in retail. I work just above minimum wage and so I don’t have medical insurance. I’ve heard of PrEP to help prevent HIV, but since I don’t have insurance, I’m not sure if and how I can still get PrEP. Is it possible? If so, how?

@Joel: This is a fairly common question that we hear, given the steep cost of the preventative drugs used as a part of PrEP. Due to the high interest level, let me provide as much information as I can about PrEP, where to get it and how to get it at reduced or at no cost at all. I’m not offering medical advice, but information that is widely agreed upon among clinicians, the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH).

PrEP, as you may know, stands for Pre-Exposure Prophylaxis, which is a method of HIV prevention, using HIV drugs by those who are HIV negative. In order to be on PrEP, your doctor may prescribe Truvada or Descovy. According to the CDC, they have an effectiveness of 99% in preventing HIV transmission during anal sex when taken consistently and as prescribed by your doctor. Note that the medical community does not recommend the use of PrEP as a substitute for condoms, since PrEP does not prevent you from getting other sexually transmitted infections. So, it’s advised to use both for maximum protection.

In order to get PrEP, you must first be HIV-negative. Your doctor will perform various blood tests to check for HIV as well as metabolic tests to check the functioning of your liver and kidneys, as some drugs show toxicity and may affect bone development in some people. You must repeat these tests every three months to refill your prescription. (So far, Descovy has been shown to have less impact on your liver and kidneys than Truvada.) When prescribed, you must take one pill a day for 7 days to achieve the maximum concentrated levels of the drug in your tissues and take a pill every day thereafter at the same time of day. It takes about 21 days for maximum protection for vaginal sex. The level of protection you will get will decrease with missed doses, so it’s important to stay consistent. I take mine first thing in the morning and it becomes routine.

There are a couple other preventative measures using PrEP that you can do. Some people prefer to take the drug around planned sexual activities rather than taking it daily. This is as effective as daily PrEP for anal sex, according to the San Francisco Aids Foundation. Called the “PrEP 2-1-1” or “PrEP on demand,” in this scenario, you take two pills two to 24 hours before sex, one pill 24 hours later, and one pill 24 hours after that. It is not recommended to do this with Descovy, as there haven’t been any trials. There is yet another method of prevention called PEP (post-exposure prophylaxis), which is taken for emergency situations within 72 hours after you believe you may have been exposed and then once or twice daily for 28 days, as recommended by your doctor.

Truvada, Descovy and other preventative medications cost more than $1,500 per month out of pocket. But there are ways to obtain these drugs for free or at a discounted cost. Both drugs are developed by GILEAD Sciences, which offers a coupon. Visit their site for more information on how to apply. Most insurance plans and state Medicaid programs cover PrEP, although prior authorization may be required. When combined with insurance, you will likely have nothing to pay at the pharmacy. If you do not have insurance, however, there are a few places that will provide free medications. Consult Prepcost.org or GetYourPrep for more information on where to find a place near you. If you have one, please also discuss with your healthcare provider.

I hope this helps you to figure out what’s the best option for you.

The @AskPeacheas column is prepared by committee but written from one person’s experience. Send emails to askpeaches [at] freshfruitinc [dot] com with “@AskPeaches” in the subject line. Be sure to give enough background, so the advice can be more specific and relevant.

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