Having unprotected sex can put you at risk for HIV, the virus that causes AIDS. But pre-exposure prophylaxis (PrEP) can block the virus from making copies if you take the medication before you've been exposed.
Using PrEP the right way could lower your risk of getting HIV from sex by as much as 99%. It could be worth taking PrEP if:
- Your partner is HIV positive.
- You have multiple sex partners.
- You don't use condoms when you have sex.
- You've had a sexually transmitted infection (STI).
- You are an injection drug user.
- You have other reasons to think you are at risk for HIV.
Today, you have options when it comes to PrEP. The medicine comes in two forms, as a pill or two injection options. It's important to talk to your doctor about whether you should go on PrEP and which type is best for you.
Types of PrEP
Pills
Descovy and Truvada are pills. They each contain two medicines, emtricitabine and tenofovir, that block the virus from making copies of itself.
- Descovy is for people who are at risk of getting HIV through sex, but not if you're at risk for HIV from sex through your vagina or injection drug use.
- Truvada is for people who are at risk of getting HIV through sex or injection drug use.
You can take the pills in one of two ways:
Daily PrEP. Taking the pills every day protects you continuously. This option may be best if you have sex two or more times a week or if your sex life is unpredictable. But you will need to remember to take your medicine every day for it to work.
PrEP 2-1-1. This on-demand dosing routine protects only when you use it. PrEP 2-1-1 is a cheaper option for gay and bisexual men who have sex once a week or less often. It offers protection against HIV when you have anal sex without a condom.
With this dosing schedule, you take:
- 2 pills two to 24 hours before you have sex
- 1 pill 24 hours after the first dose
- 1 pill 24 hours after the second dose
For the PrEP 2-1-1 method to work, you need to know in advance when you're going to have sex. And you have to pay attention to the dosing schedule to make sure you don't miss any pills.
Injections
Apretude is an injection of the medicine cabotegravir. It blocks a protein that HIV uses to copy itself inside your cells. Apretude is for people who are at risk of getting HIV through sex. The first two shots are spaced one month apart. After that you get an injection once every two months. The medicine releases slowly into your body so its effects last longer.
Yeztugo is an injection of the medicine lenacapavir. It not only blocks HIV from getting into your body but also stops the virus from making copies. The first two days, you'll take a starter dose using pills, then you'll only need one shot every six months.
Which Type of PrEP Should I Choose?
The answer to that question depends on your preferences. The best medicine for you is the one you'll take.
Do you hate needles? A pill like Descovy or Truvada means you don't have to take a shot. But you'll need to remember to take your pill every day.
Do you have trouble remembering to take a pill every day? Apretude or Yeztugo might be the better choice. Apretude is a shot you'll get every two months and Yeztugo you'll get twice a year.
Think about side effects. Also think about how the medicine might affect you. All the medicines are considered safe, but they can cause side effects like:
- Diarrhea
- Nausea
- Headache
- Tiredness
- Belly pain
On top of those side effects, Truvada sometimes damages the bones or kidneys. Descovy might be a better choice if you are at risk for osteoporosis or you have kidney disease risks such as high blood pressure or diabetes.
Consider testing visits. All PrEP medicines are for people who are HIV-negative. You will need to have an HIV test before your doctor prescribes PrEP, and then:
- Every three months while you take the pills.
- Every two months while you take Apretude.
- Every six months while you take Yeztugo.
The doctor who prescribes PrEP can help you choose the best option based on your needs.
Can I Switch Types?
If you start on one type of PrEP and you don't like it, you can change to another. For example, you might want to switch to injections if you find that pills are too hard to remember. Or you may need to take pills for a short time if you're traveling and can't get to your doctor's office for the shot.
How to Pay for PrEP
Once you've picked a PrEP type, research the cost. A one-month supply of Descovy or Truvada costs about $2,000. Add in $15,000 a year for the lab tests and doctor visits you'll need to get your prescription. Generic versions of PrEP pills are available and less expensive. They cost about $60 a month.
Apretude is $3,700 per shot, or more than $22,000 a year. And Yeztugo costs about $14,000 per shot, or more than $28,000 a year. And there isn't a generic form for the shots.
Yeztugo is about $14,100 per injection, which means $28,200 a year. There is no generic form of this drug yet, either.
Health insurance, Medicare, Medicaid, and the Veterans Administration (VA)
With health insurance, you won't pay nearly that much, or possibly anything. The Affordable Care Act requires most private insurance plans to cover the full cost of PrEP medications, plus lab tests and clinic visits, although not all of them do.
PrEP is also covered under Medicare, Medicaid, and the Veterans Administration (VA). When you get your prescription, ask your doctor's office or health insurance plan whether you have a copay. If so, find out how much you will have to pay out of pocket.
More ways to pay for PrEP
If you don't have insurance or you can't afford your copay, a PrEP navigator at your local clinic can point you to resources to help cover the cost. Here are a few of the programs that can help make PrEP drugs more affordable:
Advancing Access Patient Support Program. This program also covers Descovy or Truvada. You must have an income at or below 500% of the federal poverty level but not above 138%. When you apply, you’ll need to show you’re a U.S. resident or a resident of one of its territories. But undocumented residents are also eligible. This program is sponsored by Gilead, the maker of Descovy and Truvada.
Advancing Access Copay Coupon Program. You can get up to $7,200 each year for PrEP-related copays. All income levels can apply. You just need to be commercially insured or have Medicare without Part D benefits. To apply, you have to be a resident of the United States or its territories. This program is sponsored by Gilead.
Patient Advocate Foundation. This program can help you with up to $7,500 each year for copays. You have to make an income at or below 400% the federal poverty line plus your cost of living index. You have to either show proof of being a United States resident, a Social Security number, or alien registration number. You’ll need health insurance or Medicare.
PAN Foundation. This is only if you have Medicare. You can receive up to $3,400 per year for copays. But you need to have an income at or below 500% of the federal poverty line. You’ll need to be a resident of the United States or its territories.
Good Days. You can apply for this program if you have Medicare, CHAMPVA, Blue Cross/Blue Shield Federal, or TRICARE. You can earn up to $7,500 each year for copays. You’ll need to be a United States resident and make an income at or below 500% of the federal poverty line.
ViiVConnect Patient Assistance Program. This program can help with costs if you use Apretude.
State programs. You can also check within your state to see if they offer financial aid.
Show Sources
Photo Credit: Morsa Images / Getty Images
SOURCES:
AETC Pacific: "Quick Clinical Guide: HIV PrEP Pre-Exposure Prophylaxis."
CDC: "About PrEP," "On-Demand PrEP," "Paying for PrEP," "PrEP Effectiveness."
FDA: "Highlights of Prescribing Information: Apretude," "Highlights of Prescribing Information: Descovy," "Highlights of Prescribing Information: Truvada."
HIV.gov: "Integrase Strand Transfer Inhibitor (INSTI)," "Nucleoside Reverse Transcriptase Inhibitor (NRTI)," "Pre-Exposure Prophylaxis."
Human Rights Campaign: "Is PrEP Right for Me?"
Infectious Diseases and Therapy: "Patient-Focused Selection of PrEP Medication for Individuals at Risk for HIV: A Narrative Review."
KHN: "HIV Preventive Care is Supposed to Be Free in the US. So, Why Are Some Patients Still Paying?"
NASTAD: "Long-Acting Injectable PrEP Is Here: Frequently Asked Questions (FAQs) for Implementation."
New York State Department of Health: "HIV Pre-exposure Prophylaxis (PrEP): Individualized HIV Prevention: Frequently Asked Questions — Updated July 2022."
San Francisco AIDS Foundation: "PrEP Facts: How much does PrEP cost?" "PrEP Facts: What are the Ways to Take PrEP?"
World Health Organization: "HIV."
