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Insurance and Copay Assistance for PrEP

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Insurance and Copay Assistance for PrEP

writtenByWritten by: Mark Spera
Mark Spera

Mark Spera

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.

Read more posts by this author.
reviewBy Reviewed by: Leann Poston, M.D.
Reviewer

Leann Poston, M.D.

Leann Poston, M.D. earned her medical degree from the Wright State University Boonshoft School of Medicine. She completed an MBA from Raj Soin College of Business, focusing on healthcare. She is a full-time medical communication writer and educator.

October 15, 2021 Read Time - 4 minutes

Will My Insurance Pay for PrEP?

If you have insurance, your pre-exposure prophylaxis (PrEP) prescription should be covered. You will only need to worry about copays or, depending on your plan, deductibles. However, when starting any new medication, it is a good idea to contact your insurance company and verify your coverage. 

Gilead—the maker of Truvada—has copay assistance that makes getting on Truvada PrEP, the HIV prevention pill, extremely affordable for almost anyone. Many patients pay nothing out of pocket for PrEP.

  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

PlushCare-App-Steps

PrEP Drug Insurance and Copay Assistance

Insurance plans typically cover PrEP costs via Pharmacy Benefits. Considering that the PrEP prevention pill can cost up to $20,000 a year, this can help PrEP users save a significant amount of money.

If you book an appointment with a PlushCare doctor to discuss the PrEP drug, you’ll learn how much insurance will cover before you commit to a treatment regimen.

PlushCare also provides each patient with a PrEP Coordinator who will guide you through the payment process and check if you are eligible for assistance programs.

Buyer beware: sometimes you will be billed due to a high deductible. Make sure to check with your PrEP provider to confirm that your insurance company has been billed properly.

PlushCare has had patients on the PrEP drug covered by the following insurance plans—and more:

  • 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 started covering PrEP costs via the state’s Medicaid program, Medi-Cal. 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.

Today, “most insurance plans and state Medicaid programs cover PrEP,” according to the United States Centers for Disease Control and Prevention. “There are also other programs that provide PrEP for free or at a reduced cost,” such as Ready, Set, PrEP, which makes the HIV prevention drug available at no cost to eligible patients.


Read: CDPH Partners With PlushCare to Provide Free PrEP Statewide


  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

PlushCare-App-Steps

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 strong PrEP candidate, locate a community health center near you to learn more about available assistance programs. 

Alternatively, you can book an appointment with PlushCare to meet with a doctor on your phone and discuss your PrEP treatment options. PlushCare accepts uninsured patients for a fee of $119. If one of our experienced doctors cannot help you, you’ll get your money back.

Gilead Assistance for Truvada Costs

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 copay costs.


Read: Easy, Safe, Secure STD Testing Online


How Does Gilead Copay Assistance for Truvada PrEP Work?

Gilead requires the following stipulations be met to be eligible for Truvada PreP copay 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 the PrEP drug, you can enroll in the assistance program by mail or online.

  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

PlushCare-App-Steps

Find Affordable PrEP Treatment

Starting the HIV prevention pill can be expensive, but there are ways to make PrEP costs more 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. 


Read More About PrEP


Sources:

PlushCare is dedicated to providing you with accurate and trustworthy health information.

RX Assist. GILEAD SCIENCES. Accessed on February 6, 2021 at https://www.rxassist.org/pap-info/company-detail?CmpId=23

Centers for Disease Control and Prevention. Paying for PrEP. Accessed on September 18, 2021 at https://www.cdc.gov/hiv/basics/prep/paying-for-prep/index.html 

National AIDS Treatment Advocacy Project. Gilead U.S. Patient Assistance Program. Accessed on February 6, 2021 at https://www.natap.org/2013/HCV/121013_01.htm

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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