How to pay for PrEP

Are you thinking about starting on PrEP but worried about how to pay for it? Read on!

Is PrEP covered by health insurance?

The good news is that most health insurance plans cover some or all of the cost of PrEP. Contact your insurance provider to learn more.

Medicare covers these services without cost sharing, so you do not pay deductibles or copayments (copays). Some people with Medicare may have previously gotten PrEP for HIV drug coverage through Part D and paid a deductible, coinsurance, or copays. As of September 2024, Part B covers these drugs without cost sharing. Learn more.

Can I get PrEP without health insurance?

More good news! There are programs in Massachusetts that can help cover the cost of PrEP.

The Massachusetts Pre-Exposure Prophylaxis Drug Assistance Program (PrEPDAP) can help cover the cost of PrEP. The program is open to Massachusetts residents who are HIV-negative and meet certain income requirements. You can find out more about the eligibility on the PrEPDAP program page. If you’re eligible, PrEPDAP pays for prescription and office visit co-pays (or the full cost of the medicine if you don’t have prescription coverage).

If you’re taking PrEP or PEP to prevent HIV and need help with health insurance, CRI’s BRIDGE Team may be able to help. The BRIDGE Team provides assistance to people with health insurance issues.

What if I’m on my parents’ or partner’s insurance?

If you are on someone else’s health insurance and you are worried about them getting billed for services, you may be able to keep your billing private. Normally, the subscriber of the plan (e.g., parent or partner) gets an insurance form about your visits. It may list the place, date, and cost of the visits. Your insurance company may be able to send it directly to you instead.

The PATCH Act, a law that protects patient confidentiality when multiple people are on the same insurance plan, makes this possible. Find out more about the PATCH Act and how it can help you maintain your privacy and confidentiality.

You can ask to have your billing information kept private when you get services like:

• HIV and STD/STI tests or treatment
• HIV PrEP or PEP
• Viral hepatitis tests or treatment
• Treatment for alcohol, tobacco, and other drug use
• Mental health care
• Gender affirmation/transition care
• Partner or domestic violence support

To ask if you can receive the insurance form directly, you must call your insurance company (use the customer service phone number on the back of your insurance card). Ask if you can receive insurance billing information directly, instead of your parent or partner. Provide any information you are asked for such as the policy number on your insurance card and the visit dates. The insurance plan will inform you if you can make this change.

Find out more about how to request to keep your information private. 

What if I can’t afford retesting while on PrEP?

In order to continue on PrEP, your health care provider will likely require retesting for HIV and STDs/STIs. If you’re concerned about the cost of regular testing, check out these PrEP programs in Massachusetts that may help lower or cover the cost of testing.

Gilead, the maker of Truvada^® and Descovy^®, also offers programs to help cover the cost of PrEP. Visit the Truvada^® for PrEP or Descovy^® for PrEP sites to learn more.

Okay, I can pay for PrEP. Where can I get it?

Talk to your health care provider about getting PrEP. If your provider won’t prescribe PrEP, or if you don’t have a provider, search for services near you in Massachusetts.