What is PrEP?
PrEP stands for pre-exposure prophylaxis, which basically means you take to prevent an unwelcome outcome. In this case, it means a once-daily pill taken to prevent HIV.
How effective is PrEP?
Highly effective! Studies show that when people take the medication, it is between 92%-99% effective at preventing HIV.
What does “taking PrEP” mean? What is a treatment regimen?
A PrEP regimen includes a once-daily pill and three month check-ins with your provider for labs, STI testing, and risk/adherence counseling.
How soon will PrEP become protective after I start taking it?
Preliminary studies suggest that when starting PrEP, it may take at least seven days of the medication for PrEP to reach substantial protection levels. However, further studies are needed to confirm these findings.
Can PrEP cure or treat HIV?
No. The medications in PrEP are not enough to cure or treat HIV. PrEP only prevents HIV from taking hold in the body. If someone has HIV, they need to be on a full treatment regimen and remain in care.
Who should consider taking PrEP?
Anyone who is at-risk for HIV. The people most at-risk are:
• young gay and bisexual men who have sex with men, especially Black and Latino men
• trans people, especially trans women of color
• people in relationships with someone who is HIV positive
• any men who have sex with men
• people who inject drugs or anyone who is having sex with someone who injects drugs
• heterosexual Black and Latina women
If I miss doses, will my body become immune to PrEP?
Missing doses will not cause immunity but taking Truvada® while HIV positive will. Truvada® is not sufficient to treat HIV alone, so it is important to be tested for HIV before starting PrEP. If you do contract HIV at any time while taking Truvada®, the HIV strain could develop immunity, which could eliminate Truvada® as an effective treatment option.
However, PrEP still works even if you miss a does. You do not have to worry or double-up on the medication. Just relax and take it the next day.
Keep in mind, the more you take it, the better it will work. Taking it 5-7 days a week is important for maximum protection.
If I am on PrEP, can I stop using condoms?
Taking PrEP does not mean that you do not need to wear condoms. When taken every day, PrEP significantly reduces risk for HIV; studies show it is 92%-100% effective. However, PrEP is not effective against the transmission of other sexually transmitted infections or pregnancy. For this reason, the use of condoms is still strongly encouraged during all sexual activity. PrEP is not meant to replace condoms.
Is PrEP safe?
Yes, PrEP is well-tolerated by most people. Some people taking Truvada® report nausea, vomiting, fatigue, and dizziness in the first few weeks of taking PrEP. These symptoms usually resolve themselves over time. Other possible side effects include changes in kidney function and bone density so it is important to get check-ups with your physician every 2-3 months while taking PrEP.
Are there age restrictions with PrEP?
The CDC currently recommends PrEP for those over 18, but there are studies being conducted in younger populations now. We know that people under 18 have taken the same drug for HIV treatment, so it is safe. If someone under 18 believes they need PrEP, they should talk to their doctor or primary care provider.
Is it safe to take PrEP after drinking? Are there other drug interactions?
Truvada®is not known to interact with alcohol or other recreational drugs. Continuing to take PrEP while drinking or using drugs and having sex will help provide protection from HIV during these periods. PrEP does not interact with other drugs like hormones or birth control.
How can I pay for PrEP?
PrEP is expensive, but you shouldn’t have to pay the price. Most private insurance plans, Medicaid, and Medicare will cover a prescription for PrEP or PEP. Take advantage of this NASTAD tool at www.prepcost.org to find out the cost of PrEP through various insurance plans.
If you don’t have insurance, or if your insurance doesn’t cover enough of the costs, there are assistance programs that are easy to find and apply for that can cover some or all of the costs of the medication. Out of pocket, taking Truvada® daily will cost about $13,000 a year. Talk to your insurer to learn more about how PrEP will fit in with your health plan.
Gilead’s Medication Assistance Program (MAP) for PrEP: If you do not have health insurance, then apply for this program to see if you are eligible to get Truvada® for PrEP for free. You must not have health insurance and income verification is required. Your medical provider needs to submit an application form. If approved your medication will be dispensed to your medical provider directly. For more info call 1-855-330-5479 or visit www.truvada.com.
Gilead’s Co-Payment Assistance Program (CAP): If you have health insurance, save up to $3600 per year on your Truvada® copays. There is no income restriction for eligibility. Your medical provider or pharmacy can submit the application form. Once approved, you will be given a card and medication will be dispensed to your preferred pharmacy. For more info, call 1-877-505-6986 or visit www.truvada.com.
Patient Advocate Foundation (PAF): If you have health insurance and the medication is covered, access $7500 per year to pay for associated costs. Anyone making less than 400% of the federal poverty line (or about $47,500) may qualify for this program. This may be used to help cover the costs of copays, deductibles, and coinsurance. Income verification is required. For more information, call 1-866-316-7263 or visit www.copays.org.
Patient Access Network (PAN) Foundation: If you have health insurance and the medication is covered, access $7500 per year to pay for associated costs. Anyone making less 500% federal poverty line (or about $58,800) may qualify for this program. This may be used to help cover the costs of copays, deductibles, and coinsurance. Income verification is required. For more information, call 1-866-316-7263 or visit www.panfoundation.org.
If you are enrolled in Medicaid or Medicare or have coverage for prescription drugs under any other public program or other third party payer, then you are not eligible for Gilead’s MAP and CAP.
Am I able to access PrEP if it isn’t covered under my insurance?
Almost everyone, with or without insurance coverage, is able to access PrEP. If the medication is not currently covered under your insurance, the drug manufacturer’s (Gilead) medication assistance program (MAP) will provide the medication to you at no-cost if you meet their established criteria. Enrolling into the MAP requires proof that an individual does not have health coverage, or that the coverage they have is inadequate to cover the costs of the medication. This process may take a week or more to complete. If you need assistance, you can contact your local PrEP provider or outreach coordinator, or complete the Contact Us form on this website.
Below are the steps to obtaining PrEP for HIV Prevention through the Gilead MAP:
1. Get a prescription for PrEP from a medical provider
2. The insurance company will deny it and ask for a ‘Prior Authorization’ (PA)
3. Pharmacy will send Prior Authorization request to provider for insurance submission
4. The insurance will then deny the PA. A written appeal must be submitted by the provider on the patient’s behalf. This will be denied.
5. Once the appeal has been denied, submit the proof of denial and Gilead MAP application to Gilead and wait for approval.
How do I talk to my doctor about PrEP?
If you are thinking about talking to your doctor about PrEP, here are a few tips.
BEFORE YOUR VISIT
• Make an appointment with your healthcare provider.
• Do research. Make a list of reasons of why you think PrEP would be a good choice for you.
• Think about your routine, especially things that make it easy or difficult to take a daily medication.
• Make a health history list for your doctor. The list should include any past illnesses or concerns you have, as well as a list of all current medications (including supplements, herbs, etc.)
DURING YOUR VISIT
• Be clear. Take out your notes and tell your doctor that you are interested in PrEP right away.
• Do not be shy. Give your doctor all the details about your life that could be important to your health. Don’t worry about being judged. If your sex life is a hard thing for you to talk about, say that to your doctor. It will help start the conversation.
• Ask questions. You want to be sure that you understand what your doctor is telling you.
• Take notes during your visit so that you can remember what your doctor said.
AFTER YOUR VISIT
• Review your notes or any information provided by your doctor.
• Consider your options. Your doctor gave you a lot of information. Now it is up to you to make the right decision for you.
• Call your doctor if you have any additional questions. Ask to speak to a nurse if your doctor is unavailable.
• Schedule tests or follow-up appointment your doctor requested.
• Get your results if you had tests done at your appointment.
• If you feel comfortable, you may want to discuss your choice with your partners, family, or friends.
What if I want to stop taking PrEP?
If your risk level changes, or if you decide PrEP is no longer right for you, you can absolutely stop taking it. Any decision about starting or stopping treatment should be made with your doctor.
1. Get tested for HIV and STDs and choose a different HIV prevention strategy like condoms and/or only having sex with one partner who you trust to remain monogamous.
2. Confirm with your doctor or nurse practitioner that you are negative for Hepatitis B as the medication used for PrEP is also used in Hepatitis B treatment and discontinuing treatment when you need it may cause harm.
3. Continue taking PrEP for at least two days after a potential exposure to HIV.