PrEPcost.org is currently closed. A new version of PrEPcost.org will be available for the Marketplace Open Enrollment Period in early November 2018.
 
PrEPcost.org is an online health plan finder for PrEP. It is 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.
 
Our team at NASTAD is eager to coordinate with PrEP programs and insurance assistors across the country. Sign up for updates about PrEPcost.org, visit our resources page below, and feel free to send us questions and suggestions for the site to PrEP@NASTAD.org.

PrEP Locator: Find Your Provider

Co-pay Assistance Programs for PrEP

 A co-pay assistance program for PrEP is available from the manufacturer of Truvada®, the medication for PrEP.

• REMINDER: The program’s assistance was automatically included in the total cost estimate on PrEPcost.org
• WHAT IT COVERS: Starting on January 1, 2018, the co-pay card covers the patient’s out-of-pocket costs for the medication up to $4,800 per year. It does not cover out-of-pocket costs for clinical visits or labs.
• WHO IS ELIGIBLE: It is available to individuals who have private health plan coverage, including Marketplace plans like the ones on PrEPcost.org, and to those with employer-sponsored plans. There are no income restrictions to access this program.
• HOW IT WORKS:
  1. Follow the link below, or call 1-877-505-6986 for assistance.
  2. Complete the online application, selecting Co-pay Support, then “Truvada” for the medication, and indicate that you intend to use it “to reduce the risk of getting HIV-1.” You will know immediately if you are eligible for assistance.
  3. Save or print the program’s card to use to pay for the medication at the pharmacy. 

Note: Kaiser Permanente health plans require clients to apply for the Gilead Co-pay Coupon Card, then pay for the medication directly and submit a reimbursement form through the website: www.patientrebateonline.com

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The Patient Advocate Foundation’s Co-Pay Relief Program is also available for PrEP.

• WHAT IT COVERS: It covers the patient’s out-of-pocket costs for the medication up to $7,500 per year. It does not cover out-of-pocket costs for clinical visits or labs.
• WHO IS ELIGIBLE: It is available to individuals who have health insurance that covers Truvada® and whose income falls below 400% of the Federal Poverty Guideline, adjusted by the Cost of Living Index and the number in the household.
• HOW IT WORKS:
  1. Follow the link below, or call 1-866-512-3861, Option 1 for assistance.
  2. Register for the program and then complete the online application. You will know if you are eligible for assistance within 10 minutes of submitting the application. An income verification may also be required.
• NOTE: Assistance from Patient Advocate Foundation’s Co-Pay Relief Program assistance was NOT included in the total cost estimate on PrEPcost.org.

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Truvada for PrEP Patient Assistance Program for Uninsured Individuals

For uninsured individuals, Gilead Advancing Access® can help cover the cost of Truvada® for PrEP.

• WHAT IT COVERS: The program provides financial assistance to pay for Truvada®, the medication for PrEP. It does not cover the cost of clinical visits or labs.
• WHO IS ELIGIBLE: The program is available to uninsured individuals, regardless of immigration status. The household income limit for the program is 500% FPL ($60,300 per year in all states except Hawaii and Alaska). Applicants will be asked to submit further documentation as proof of income.
• HOW IT WORKS:
  1. Follow the link above, or call 1-800-226-2056 for assistance.
  2. Complete the online application, selecting “Uninsured Support,” then “Patient Assistance Program (PAP) Eligibility Screening.” Select “Truvada®” for the medication, indicate that you intend to use it for PrEP, and enter your personal information. Your PrEP provider will also need to complete a portion of the application.

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Additional State Resources

State-specific resources for PrEP users, navigators, and providers are available on PleasePrEPMe.
 

Special Considerations when Enrolling Clients

• ​Lawfully present non-citizens in Medicaid expansion states. Lawfully present non-citizens in Medicaid expansion states whose incomes are within Medicaid levels, but who are ineligible for Medicaid due to their immigration status, may still be eligible for premium tax credits. These consumers should enroll directly through healthcare.gov or their state’s marketplace. 
• Lawfully present non-citizens in states that have not expanded Medicaid. Lawfully present non-citizens in non-expansion states whose incomes are below 100% FPL may still be eligible for premium tax credits, depending on how recently they moved to the U.S. These consumers should enroll directly through healthcare.gov or their state’s marketplace. 
• Medicare enrollees and Medicare-eligible consumers. Current Medicare enrollees may not purchase Marketplace coverage even at full price. Medicare enrollees who pay a premium for Part A must drop their Medicare coverage before enrolling in a Marketplace plan, and may then be eligible for premium tax credits. Medicare enrollees who do NOT pay a premium for Part A may not purchase a new Marketplace plan and would be ineligible for premium tax credits. Consumers who may be eligible for Medicare should confirm their Medicare eligibility and enrollment status before purchasing Marketplace coverage. 
• Household size. PrEPcost.org estimates costs for a one-person household. Individuals in a household with two or more people may be eligible for additional tax credits not included in the estimate, or for insurance through a government program like Medicaid or CHIP. This is because financial assistance is based on the federal poverty guidelines, which depends on both your household income and household size. If you think you or your family members may be eligible for Medicaid, submit an application through healthcare.gov or your state marketplace to get an eligibility determination. Check this list of Medicaid and CHIP eligibility levels. If you need to shop for a family plan, use one of the plan finders below or visit your state marketplace. 
• Pregnant women. Pregnant women may be eligible for Medicaid or CHIP on the basis of their pregnancy, even if their income is otherwise too high for these programs. If you are uninsured and pregnant, and you think you may be eligible for Medicaid or CHIP, visit healthcare.gov or your state’s marketplace to get a Medicaid/CHIP eligibility determination. If you are already receiving APTCs when you become pregnant, you may choose between keeping your APTCs or enrolling in Medicaid, even if your pregnancy makes you eligible for Medicaid.  
• Children’s Health Insurance Program (CHIP). CHIP coverage of PrEP varies by state. Please check with your state’s CHIP agency or your insurer to find out if PrEP is covered by your CHIP plan. 
• Provider networks. If you already have a provider and you want to make sure to pick a plan that includes that provider in its network, check one of the plan finders listed at the bottom of the page. 

Other Useful Health Plan Finders 
To find health plans in the federally-facilitated Marketplace, visit: Healthcare.gov, or Health Sherpa.

State-based Marketplaces 

State-based PrEP Assistance Programs 
 

Colorado 
The Colorado Public Health Intervention Program (PHIP) may cover the remaining cost of PrEP for insured individuals who qualify for the program. For more information about the program or to enroll online, visit coenroll.com. Visit proudtobeprepped.com to learn about the different options to pay for PrEP in Colorado. 
 

Illinois 
The Illinois Pre-exposure Prophylaxis (PrEP) Assistance Program may be able to help PrEP candidates pay for the out-of-pocket costs for Truvada. For more information about the program or to enroll online, visit www.prep4illinois.com, or call the program’s hotline: 1-800-825-3518.
 

Massachusetts 
The Massachusetts Pre-Exposure Prophylaxis Drug Assistance Program (PrEP-DAP) may be able to help PrEP candidates pay for the out-of-pocket costs for the medication. Visit the program’s website to find out more: https://crine.org/hdap/prep-drug-assistance-program/  or call CRI’s PrEP Coordinator at 617-502-1737 (or toll free at 800-228-2714 x3737).
 

New York 
The New York State Department of Health Pre-exposure Prophylaxis Assistance Program (PrEP-AP) may be able to help you cover clinical visits and labs for PrEP. However, clients must receive the services from an enrolled PrEP-AP provider. Call 1-800-542-2437 to enroll and for more information, visit:  https://www.health.ny.gov/diseases/aids/general/resources/adap/index.htm. 
 

Washington State 
The Washington State PrEP drug assistance program helps insured HIV-negative Washingtonians pay for the out-of-pocket cost of the medication. Please visit www.doh.wa.gov/prepdap or contact the Early Intervention Program at 1-877-376-9316 for more information.

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