Pre-Exposure Prophylaxis (PrEP) is a medication regimen used by people who do not have Human Immunodeficiency Virus (HIV) to prevent acquiring the infection. Taken as a daily pill or an injectable, PrEP works by stopping the virus from establishing itself in the body after potential exposure. PrEP is highly effective when used as directed, reducing the risk of sexual transmission by about 99%. Obtaining and maintaining access to this medication involves necessary steps, including medical screenings, finding a provider, and addressing financial aspects of care.
The Essential First Step: Getting a Prescription
PrEP is not available over the counter and requires a prescription from a licensed healthcare provider due to mandatory medical prerequisites. The most important initial requirement is a confirmed negative HIV status immediately before starting the medication. Taking PrEP with an undiagnosed HIV infection can cause the virus to become resistant to the drugs, complicating future treatment.
The initial screening process also includes baseline tests to ensure the medication is safe. A blood test is performed to measure kidney function (eGFR), as certain oral PrEP drugs are processed through the kidneys. Testing for other sexually transmitted infections (STIs), such as syphilis, chlamydia, and gonorrhea, is routine, as is screening for Hepatitis B and C.
Identifying Potential Providers and Locations
A wide array of healthcare professionals, including physicians, nurse practitioners, physician assistants, and specially trained pharmacists, are authorized to prescribe PrEP. Patients can begin their search with their current primary care provider (PCP). If a PCP is unfamiliar with PrEP protocols, they may refer patients to a specialist or a dedicated clinic.
Specialized sexual health clinics, infectious disease clinics, and Federally Qualified Health Centers (FQHCs) often have extensive experience with PrEP. These locations frequently employ PrEP navigators who streamline the process of testing, prescription, and financial assistance. Telehealth, or “tele-PrEP,” offers a convenient option, allowing virtual consultations, at-home testing kits, and discreet medication delivery.
Once a prescription is issued, the medication can be filled at a local retail pharmacy or through a mail-order pharmacy. Mail-order services typically ship a 90-day supply directly, while local pharmacies offer immediate availability and in-person consultation.
Understanding Cost and Financial Assistance
While cost can be a barrier, numerous programs exist to make PrEP affordable or free, regardless of insurance status. Most private insurance plans and public programs like Medicaid and Medicare now cover PrEP. Under the Affordable Care Act (ACA), PrEP is considered a preventive service, meaning most health plans must cover the medication and related lab tests with no patient copayment or deductible.
For those with commercial insurance, manufacturer co-pay assistance programs are available to cover out-of-pocket costs. Uninsured individuals can access PrEP through manufacturer patient assistance programs, such as Gilead’s Advancing Access program, which provides the medication at no cost based on income limits. Many states also offer assistance programs that cover the costs of clinical visits, lab work, and the medication for eligible residents.
PrEP navigators at clinics and health centers are a valuable resource for guiding patients through the application processes for these financial aid options.
Maintaining PrEP Use
Obtaining the initial prescription requires an ongoing commitment to HIV prevention and continuous medical monitoring. Individuals taking oral PrEP must return for follow-up appointments and laboratory testing every three months to confirm they remain HIV-negative and to refill the 90-day prescription. The quarterly lab work includes repeat HIV testing, monitoring kidney function every three to six months, and repeat STI screening (chlamydia, gonorrhea, and syphilis). Regular follow-up allows the provider to assess medication adherence, address potential side effects, and ensure the patient remains protected.