Covering the Costs of PrEP and PEP
Paying for PrEP
Most health plans cover most PrEP care costs. For many people, it’s as routine as paying for any other prescription. However, if you cannot afford your out-of-pocket costs or are uninsured, the patient assistance programs below could help. Each program uses the Federal Poverty Level (FPL) to determine a person’s income.
DOL, HHS, and UST – FAQs About the Affordable Care Act Implementation
FAQs regarding the Affordable Care Act's implementation from the US Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (UST).
Covering Costs of PrEP Job Aid
Tips and Resources for Covering Costs of HIV PrEP from HealthHIV.
Gilead Advancing Access Patient Support Program (Oral PrEP)
- Covers cost of Truvada or Descovy
- Income at or below 500% FPL but above 138% FPL (Medicaid eligible)
- Resident of the U.S. or its territories; SSN not required; undocumented residents eligible
- Must be uninsured, insurance denies coverage, or have Medicare with no Part D benefits
- This program does not use public charge as an eligibility determination
ViiVConnect Savings Program (Injectable PrEP)
- Covers cost of Apretude and injection support services
- Copay assistance: no income limit;
Medication assistance: income at or below 500% FPL - Copay assistance: commercial insurance;
Medication assistance: ineligible for Medicaid/Mi Salud Health AND no prescription drug coverage OR have a Medicare Part B or D or Advantage Plan OR limited commercial insurance plan - Resident of the U.S. or its territories; Social Security Number (SSN) not required
- Check to see if ViiVConnect is used as a determination for public charge
NASTAD – Billing and Coding Guides for HIV Prevention
Billing and coding guides for HIV prevention from NASTAD (the National Alliance of State and Territorial AIDS Directors).
USPHS – 2021 PrEP Guidelines, Clinical Providers’ Supplement
The clinical providers' supplement to the 2021 PrEP guidelines from the USPHS (United States Public Health Service).
State PrEP Assistance Programs
NASTAD maintains a list of PrEP assistance programs in a variety of states.
NeedyMeds
NeedyMeds is a 501(c)(3) national non-profit that connects people to programs that will help them afford their medications and other healthcare costs.
EBGTZ – Same-day Oral PrEP Guide
A same-day oral PrEP guide from East Bay Getting to Zero.
Patient Advocate Foundation Co-Pay Relief
Patient Advocate Foundation (PAF) is a national 501 (c)(3) non-profit organization which provides case management services and financial aid to Americans with chronic, life threatening and debilitating illnesses.
- Provides up to $7,500 per year for prescription copays
- Income at or below 400% FPL plus cost of living index
- U.S. resident; SSN or alien registration number required
- Must have health insurance (includes Medicare)
- This program does not use public charge as an eligibility determination
CMS – Covering HIV PrEP Under Medicare
FAQs regarding covering HIV PrEP under Medicare from CMS (the Centers for Medicare and Medicaid Services).
Gilead Advancing Access Copay Coupon Program
- Provides up to $7,200 per year for prescription copays
- Any income level is eligible, no lifetime limit
- Resident of the U.S. or its territories; SSN not required
- Must be commercially insured, or have Medicare with no Part D benefits
- This program does not use public charge as an eligibility determination