16. What are the insurance and payment options for PrEP?
Many insurance plans cover PrEP. TDF-FTC is on the California Medi-Cal formulary and Medi-Cal completely covers the cost of TDF-FTC as PrEP, as well as medical visits and laboratory testing. Prior authorization is NOT required.
Several programs have been established to help cover the cost of PrEP and associated care, including the following three.
Gilead Advancing Access Patient Assistance and Co-pay Coupon Programs
The manufacturer of Truvada (Gilead) has established programs to help cover the cost of PrEP. Advancing Access provides assistance to patients who are uninsured or underinsured, or who need financial assistance to pay for Gilead medications.
- Access to counselors who can help patients and their providers with insurance-related questions, including coverage options.
- Patient Assistance that provides medications at no charge for eligible patients with no other insurance options. Patients must have annual income less than 500% of the Federal Poverty Level (FPL). In 2017, 500% of FPL is $60,300 for a one-person household.
- Co-pay assistance for eligible patients (up to $3,600 in co-pays per year with no monthly limit).
For more information, call 1-800-226-2056 or visit www.gileadadvancingaccess.com
Los Angeles County Department of Public Health PrEP Centers of Excellence (PCOE)
In August 2016, DHSP funded nine community agencies and clinics at 14 sites throughout Los Angeles County to serve as “PrEP Centers of Excellence”. The PCOEs offer PrEP at low cost for patients at high risk for HIV acquisition who are uninsured or underinsured. These PCOEs are community clinics with expertise in sexual health, which also offer essential services to address social determinants of health that prevent patients from achieving optimum health, such as benefits navigation, mental health, and substance abuse referrals.
- Patients must be LA County residents
- Patients must have an income of <500% FPL
For more information, visit http://getprepla.com/centers-excellence.html or call 1-844-YEA-PREP.
Patient Access Network (PAN) Foundation:
The PAN Foundation offers services to people with chronic disease for whom cost limits access to critical medical treatment due to rising deductibles and co-pays.
- Offers one-time grants to cover up to $7,500 of prescription costs for one year.
- Patient must have private insurance, Medicare, or Medicaid.
- Patient must have an income <500% FPL or if their income is above this they may still qualify if their prescription costs exceed 10% of their income.
For more information, call 1-866-316-7263 or visit www.panapply.org
The retail cost of PrEP medication is approximately $1,400 to $1,600 per month.