Health Insurance Valid For International Travel
August 22, 2022Options For Digital Nomads Health Insurance
September 5, 2022How To Obtain Prep Whether You Have Insurance Or Not
Here's what doctors have to say about getting PrEP for HIV prevention, whether you have insurance or not.
Pride month is a time for the LGBTQ community to celebrate its achievements while also addressing the many challenges that remain. One of these issues is HIV.
According to the Kaiser Family Foundation, the number of new HIV infections in the United States has decreased by more than 70% since 1984, and by roughly 10% between 2015 and 2019. According to the Centers for Disease Control and Prevention, a set of drugs known as pre-exposure prophylaxis, or PrEP, can reduce the risk of contracting HIV from intercourse by up to 99%.
According to the CDC, PrEP is a critical preventative approach for its Ending the HIV Epidemic in the United States campaign. By 2030, the organization hopes to have 50% of at-risk, HIV-negative persons taking PrEP, up from 25% in 2020 and 3% in 2015.
So, why isn't PrEP used by everyone who could benefit from it? Money is an important consideration.
Without insurance, a one-month supply of Truvada, the most widely accessible PrEP medicine, costs about $2,000, and a recently approved generic variant can still cost up to $60 per month. PrEP-related lab testing may incur additional charges.
According to the Center for American Progress, millions of LGBTQ Americans — 16% of those earning less than $45,000 a year — were uninsured in 2020.
If you want to take PrEP, here's what doctors advise about how to get it, whether you have insurance or not.
How To Obtain A Prescription For PrEP
Obtaining and maintaining a PrEP prescription necessitates some tests ordered by your doctor, according to Dr. Errol Fields, an assistant professor of pediatrics and adolescent medicine subspecialist at the Johns Hopkins University School of Medicine in Maryland and an HIV treatment and prevention specialist.
"To be started with PrEP, you need to be tested for HIV to ensure you don't have HIV, and you need to obtain other blood work to ensure PrEP is safe for you to take," he explained via email.
PrEP is available in two daily pill formulations, Truvada and Descovy, as well as a biweekly injectable formulation, Apretude.
"While on PrEP, you'd be tested before each new prescription (every three months) or injection (every two months) to ensure you're still HIV-negative," he explained. These routine tests may result in lab costs or copays.
Once you've received a PrEP prescription, you can choose how to pay for it.
Is PrEP Covered By Health Insurance?
Since a 2019 ruling by the U.S. Preventive Services Task Force, all health insurance plans regulated by the Affordable Care Act, including catastrophic health insurance policies, have been required to cover some form of Prep. The same judgment barred insurers from charging out-of-pocket expenses for PrEP.
"Most insurances are directing patients to generic Truvada for cost savings, but will cover brand Truvada, Descovy, and (occasionally) Apretude with a prior authorization," said Dr. Marcus Sandling, clinical director of sexual health at Callen-Lorde Community Health Center in New York, in an email interview.
Prior authorization is the process by which your doctor obtains insurance preapproval to pay for a specific drug.
You can use your health savings account or flexible spending account to pay for PrEP-related lab fees and copays.
But What If You Don't Have Insurance?
How To Obtain PrEP Without Health Insurance
"Fortunately, there are various options available to help those who are having difficulty receiving or paying for PrEP," Fields added. "There are nationwide websites with resources for finding PrEP providers and paying for PrEP, such as pleaseprepme.org." There are also federal and state support programs available, such as Ready, Set, PrEP."
Ready, set, go! PrEP is a federal initiative that enables uninsured Americans to apply for free PrEP through the mail or at participating pharmacies.
PrEP payment assistance programmes are also available in thirteen states and Washington, D.C. More information on these programs can be found on the website of the National Alliance of State and Territorial AIDS Directors.
Gilead Sciences, the maker of Truvada and Descovy, offers a program called Advancing Access that assists uninsured patients with copays and drug costs. Aperture's maker, ViiV, has a similar copay assistance program called ViiV Connect.
If, after exhausting all other alternatives, you still have medical expenses from PrEP, you may be eligible to deduct the medical bills from your taxes if they exceed 7.5% of your gross income and you itemise your deductions.