PrEP, or Pre-Exposure Prophylaxis, is a daily pill that helps protect people from getting HIV. It’s like wearing a shield. It lowers the chances of catching HIV by a lot if taken regularly. This medicine is especially important for people who might be at higher risk of getting HIV from sex or sharing needles. But some people wonder, “How much does PrEP cost?” The good news is that insurance can help make PrEP more affordable. How much you actually pay depends on your insurance plan, but there are also programs that can make it cheaper or even free depending on your situation.

What is PrEP and Why is it Important?

PrEP is a medicine that stops HIV from spreading in your body if you’re exposed to it. It’s very effective, lowering the risk of getting HIV by about 99% when taken every day. For people who want to protect themselves, PrEP is a great option. But like any medicine, PrEP comes with a price. Without insurance, it can cost hundreds or even thousands of dollars a month, which is too expensive for most people. That’s why insurance and special help programs are so important. They make sure people who need PrEP can afford it and stay healthy.

How Does Insurance Help Cover the Cost of PrEP?

If you have health insurance, there’s good news: PrEP is almost always covered. Thanks to government rules, most insurance companies have to cover PrEP without any copays. This means you may not have to pay anything for the medicine itself. That being said, you might still have to pay for doctor visits or lab tests, which are also part of getting PrEP. It’s always a good idea to check with your insurance company to find out exactly what’s covered and if you’ll have any extra costs.

If you have Medicaid, PrEP is also covered in most states. Some state programs even go beyond this and provide extra help to make sure PrEP is completely free. For people without insurance, there are still ways to get PrEP at a lower cost or even for free, which we’ll talk about later.

What Factors Can Affect the Cost of PrEP with Insurance?

The actual cost of PrEP with insurance can depend on several factors. First, the type of insurance plan you have matters. Some plans cover all the costs, while others might require you to pay part of the cost, like a copay for your lab tests. Your deductible can also affect how much you pay for PrEP. If you haven’t met your deductible, you might have to cover more costs yourself at the start of the year.

Where you get your PrEP prescription filled can also make a difference. Some insurance plans work with specific pharmacies and give discounts if you use those. It’s a good idea to ask your insurance company which pharmacy they recommend for the lowest cost.

How Can You Find Out the Cost of PrEP With Your Insurance?

If you’re considering starting PrEP, the best first step is to call the customer service number on your insurance card. Tell them you’re interested in PrEP and ask what’s covered under your plan. Some key questions to ask include:

  • Is the medicine itself fully covered, or will I have a copay?
  • Are doctor visits and lab tests for PrEP covered?
  • Do I need to meet a deductible first?
  • Are there specific pharmacies I should use to save money?

Your doctor or clinic can also help by communicating with your insurance company. They can check what’s covered and might even be able to help you apply for programs that reduce costs.

What If PrEP Still Feels Too Expensive?

Even with insurance, some people might struggle to afford PrEP because of extra costs, like lab tests. But don’t worry. There are programs designed to help. For example:

  • Patient Assistance Programs (PAPs): These programs are offered by companies that make PrEP. If you qualify, they might provide the medicine to you for free or at a very low cost.
  • Copay Assistance Programs: These programs help cover copays, so you pay less—or nothing—at the pharmacy. Some programs even help with costs for doctor visits or lab tests.
  • State PrEP Programs: Many states have their own programs to help people get PrEP for free or at reduced costs. Ask your clinic or local health department if such programs exist in your area.
  • Community Clinics: Many clinics offer PrEP services on a sliding scale, where you pay less if you have a lower income.

These options make PrEP possible for almost everyone who needs it.