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Insurance and Copay Assistance for PrEP

October 10, 2018 Read Time - 4 minutes

About Author

Mark grew up in a family of healthcare providers and has always been fascinated by preventative medicine, infectious diseases and the intersection of big data and healthcare.

Will My Insurance Pay for PrEP?

If you have insurance, your PrEP prescription should be covered. You will only need to worry about copays or, depending on your plan, deductibles. 

Gilead — the maker of Truvada — has copay assistance that makes getting on PrEP extremely affordable for almost anyone.


Many patients pay nothing out of pocket.


Prep insurance and copay assistance

Insurance plans should cover the cost of the medication via Pharmacy Benefits, which is great news given that the drug can cost up to $20,000 a year.

If you book an appointment with a PlushCare doctor for PrEP, you will be able to learn how much insurance will cover before you commit to a treatment regimen.


You will also get assistance from a PrEP Coordinator who can guide you through the payment process and check to see if you are eligible for an assistance programs.


Buyer beware: sometimes you will be billed due to a high deductible. Make sure to check with your PrEP provider to confirm the insurance has billed properly — even they make mistakes.

PlushCare has had patients on PrEP covered by the following insurance plans, plus more:

  • UnitedHealthcare
  • Cigna
  • Blue Cross Blue Shield
  • Blue Shield of California
  • Anthem Blue Cross
  • Aetna
  • Humana
  • Molina
  • Delta Health
  • Marketplace Plans
  • IEHP
  • Healthnet
  • TriCare
  • Highmark
  • Coventry
  • Oxford
  • Carefirst
  • Medi-Cal
  • MediCare

In 2014, California made a splash by covering PrEP via California’s Medicaid program, Medi-Cal. California was the first state to do so.

Jim Pickett, Director of Prevention Advocacy and Gay Men’s Health at AIDS Foundation of Chicago, told Healthline.com that clients who come to him for information about PrEP often find that it is more affordable than they’d expected.

California continues to lead the way in making PrEP accessible as the California Department of Public Health (CDPH) has partnered with PlushCare to provide free access to PrEP statewide.


Read: CDPH Partners With PlushCare to Provide Free PrEP Statewide

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How to Get PrEP Without Insurance

You can absolutely get PrEP without insurance. If you’re uninsured, the best route to getting PrEP is to visit Gilead’s Advancing Access website and fill out a quick form to better understand your options.

If you don’t have insurance but think you would make a very strong PrEP candidate, you should locate a community health center near you to learn more about available assistance programs.

Or book an appointment with PlushCare to meet with a doctor on your phone and discuss your options.


PlushCare accepts uninsured patients for a flat rate fee of $99. If the doctor can’t help you, you get your money back.


Gilead Assistance for PrEP

Gilead is the company that makes the brand name PrEP drug, Truvada.

Gilead has a Copay Assistance Program that can be used in conjunction with private insurance to offset the price recommended for all privately insured patients to help offset a high deductible, or to simply offset the copays.

Gilead requires the following stipulations be met to be eligible for assistance:

  • Negative results on an HIV test taken within 90 days of the prescription.
  • Proof of U.S. residency (bank statements, utility bills, and other documents that have your name and U.S. address).
  • Proof of income that shows you are under 500 percent of the poverty line in your area.

Once you have found a healthcare provider willing to prescribe PrEP, you can enroll in the assistance program by mail or online.

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Conclusion

PrEP is expensive, but there are ways you can make it affordable. Between your insurance and Gilead’s copay assistance, you should be paying very little for PrEP.

Click here to book a PrEP consultation on your phone.


For other reads about PrEP, visit our articles below:


Sources

Gilead.com. Advancing Access. Accessed on October 10, 2019 at https://www.gileadadvancingaccess.com/

Medicalnewstoday. Truvada. Accessed on October 10, 2019 at https://www.medicalnewstoday.com/articles/325820.php

Most PlushCare articles are reviewed by M.D.s, Ph.Ds, N.P.s, nutritionists and other healthcare professionals. Click here to learn more and meet some of the professionals behind our blog. The PlushCare blog, or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. For more information click here.

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