Finding Affordable Health Care Coverage for PrEP 

By Edwin Corbin-Gutiérrez February 16, 2018

Pre-exposure prophylaxis (PrEP) is a daily medication for individuals who are not living with HIV that can help prevent new infections. It is an effective, but underutilized, prevention tool that can stop HIV transmissions and help end the epidemic. Today, although most health insurance plans cover it, affording the out-of-pocket costs for PrEP continues to be a major concern.

For PrEP candidates who can get coverage through the individual Marketplace, a persistent challenge has been health plan navigation. To support PrEP navigators and Marketplace assistors with this challenge, NASTAD recently released PrEPcost.org. PrEPcost.org is an online health plan finder for PrEP. NASTAD worked with a web developer (Clear Health Analytics) and national health insurance data vendor (Vericred) to create an easy-to-use web-based tool to help people find the most affordable Marketplace plan that meets their needs for PrEP coverage. PrEPcost.org can assist navigators by searching across plans in the Marketplace and evaluating PrEP coverage to find the best options available. In its search, the site looks up the medication in each plan’s formulary to assess how the medication is covered, and applies income-based savings to monthly premiums for each plan. It then calculates out-of-pocket expenses for the clinical visits, labs, and the medication, and it applies the manufacturer’s co-pay card to that estimate.

Fortunately, this complex process happens on the back-end so that the user can compare plans based on the total estimated out-of-pocket costs of PrEP, making it easier for users to compare them, and sign up for a plan. A three-minute introduction to the site is available on NASTAD’s YouTube channel. Even though the open enrollment period has closed, PrEPcost.org will be available throughout the year for anyone who qualifies for a Special Enrollment Period.

Given the interest in the site that NASTAD received, our team is already preparing for the next Marketplace open enrollment period this November. We are exploring how to expand the site’s functions and coordinate with PrEP programs and insurance assistors across the country. Sign up for updates about PrEPcost.org, visit our resources page, and feel free to send us questions and suggestions for the site to PrEP@NASTAD.org.