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Have questions about PrEP?

Cost:

How much does PrEP cost?

PrEP is covered under the vast majority of health insurance plans. Copays will vary by insurance and there are options available if you have a high copay or deductible. If you don’t have health insurance, there are financial assistance programs that provide access to affordable/free PrEP. Without any assistance or insurance, the cost of Truvada is roughly $2,000 for a 30 day supply of medication.

What if I don't have insurance?

You can still be on PrEP. The California PrEP Assistance Program (PrEP-AP) reimburses care providers for the cost associated with PrEP-related care and laboratory services to uninsured or under-insured patients. Gilead, the pharmaceutical company that makes PrEP, offers medication payment assistance through its Gilead Advancing Access Program. The programs work together to provide uninsured patients access to PrEP. 

In order to qualify for PrEP-AP, your gross income must fall under 500% of the Federal Poverty Level, which is $62,450 annually for a single individual and $84,550 for a household of two. Gilead’s Advancing Access Program does not have income limits; however, it is only effective for one year or until you reach the $7,200 use limit. You may re-apply for Gilead’s Advancing Access program on an annual basis. For more information about PrEP-AP, visit: https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_adap_resources_prepAP.aspx

For more information about Gilead’s Advancing Access Program, visit: https://www.gileadadvancingaccess.com/copay-coupon-card

Another program, the “The Ready, Set, PrEP program” makes PrEP medication available at no cost for qualifying recipients. To see if you qualify, you can complete the online registration: https://getyourpreppatient.iassist.com/

I'm still on my parents' insurance. Will they know I'm on PrEP?

Your insurance company may send some of your confidential health information to the policyholder (e.g., parents) of your health plan. This information may include the services you received and the date you received them. You are able to protect your privacy by contacting your insurance company to request that they do not disclose sensitive information related to PrEP and sexually transmitted infections (STIs/STDs) to anyone other than yourself. This is called a “Request of Confidential Information”. The state of California requires your insurer to honor your request and keep your sensitive health information private. 

How can I get PrEP if I have a high deductible with my health insurance?

A deductible is the amount you must pay (out-of-pocket) in order for your health insurance to cover all expenses. If you find out you have a high deductible or your copays are too high, there are options available to make PrEP affordable. Individuals with private insurance who make below 500% of the Federal Poverty Level, which is $62,450 annually for a single individual and $84,550 for a household of two, may enroll in the PrEP Assistance Program (PrEP-AP). This program will help cover the cost of high deductibles along with PrEP-related care. 

Individuals with private insurance may also apply for Gilead’s Advancing Access Program. Gilead’s Advancing Access Program will assist with copays for PrEP. The coupon card will only cover the cost of PrEP, it will not cover the cost of medical and lab visits associated with PrEP. The Advancing Access Program is not income based; however, it is only effective for one year or until you reach the $7,200 limit. You may re-apply for the program on a yearly basis. 

For more information about PrEP-AP, visit: https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_adap_resources_prepAP.aspx

For more information about Gilead’s Advancing Access Program, visit: https://www.gileadadvancingaccess.com/copay-coupon-card

What if my annual income is too high?

If you have commercial insurance with a household income over 500% of the Federal Poverty Level, approximately $65,000 annually for a single individual and $85,000 for a household of two, Gilead’s Advancing Access Program may be able to help. Gilead’s Advancing Access Coupon Card will cover up to $7,200 a year of PrEP copays. This means that some people may have medication copays as low as $0. 

The cost of copays for PrEP depends on your insurance. Many insurances consider PrEP a specialty drug and copays may be higher than lower tier drugs. Some insurance plans may require you to pay the full deductible amount before they start paying for PrEP. A deductible is the total amount you pay out-of-pocket in a single calendar year for covered health care services before your insurance plan starts to pay. If your insurance requires you to pay a deductible before they pay for PrEP, the Gilead coupon card may help you cover the cost of the deductible along with your PrEP copays for the remainder of the $7,200 yearly balance. 

You may apply for the Gilead’s Advancing Access Program Coupon card on a yearly basis. The coupon card will only cover the cost of PrEP, it will not cover the cost of medical and lab visits associated with PrEP.

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