What to Know About State-Funded PrEP-DAP Programs
Cost is often a barrier to starting PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. Fortunately, the HIV prevention landscape is rapidly evolving, and PrEP is now more accessible than ever.
As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. In addition, many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply for state-funded PrEP drug assistance programs — also referred to as PrEP-DAP or PrEP-AP programs — in four of the states that Alto serves.
The State of California’s PrEP Assistance Program (PrEP-AP) helps cover PrEP-related medical expenses, with different benefits for individuals without insurance, those with private insurance, and those with Medicare.
If you don’t have insurance:
You can receive Truvada®, one of the two FDA-approved PrEP medications, free of charge through Gilead’s Advancing Access® Program. California’s PrEP-AP will also provide financial assistance with all other medications on the PrEP-AP formulary for HIV prevention and treatment of sexually transmitted infections (STIs) and the following PrEP-related medical services:
- Initial PrEP assessment
- HIV testing
- STI testing
- Pregnancy testing
- Renal function
- Hepatitis A screening
- Hepatitis B screening
- Hepatitis C screening
To be eligible for the assistance, you must receive all PrEP-related medical services at approved locations within the California Department of Public Health’s Office of AIDS PrEP-AP Provider Network. Search for a California PrEP-AP provider or enrollment site near you.
If you have private insurance:
Gilead’s Co-Payment Assistance Program covers up to $7,200 of Truvada® copays per calendar year. Once you’ve met this threshold, California’s PrEP-AP will cover any remaining PrEP copays for the rest of the calendar year, in addition to assistance for out-of-pocket costs for PrEP-related medical services and all other medication on the PrEP-AP formulary for HIV prevention and STI treatment. To be eligible for assistance with PrEP-related medical services, you must see a provider in your insurance plan’s network.
If you have Medicare:
If you have prescription medication coverage through Medicare, you are not eligible for financial assistance from Gilead, but California’s PrEP-AP offers financial assistance with copays for all medications on the PrEP-AP formulary including Truvada®.
If you do not have prescription medication coverage through Medicare, you are eligible to enroll in Gilead’s Patient Assistance Program and receive Truvada® free of charge. In addition, California’s PrEP-AP will provide assistance with all other medications on the PrEP-AP formulary.
Anyone who has outpatient coverage through Medicare is also eligible to receive assistance from California’s PrEP-AP for PrEP-related medical services. However, you must see a provider in your plan’s network.
To be eligible for California’s PrEP-AP, you must:
- Be a California resident
- Have a negative HIV test dated within six months of the PrEP-AP application
- Be at least 18 years old
- Have an annual Modified Adjusted Gross Income (MAGI) that does not exceed 500% of the Federal Poverty Level based on family size and household income
- Not be fully covered by Medi-Cal or other third party payers
- Be enrolled in the manufacturer's assistance program, if eligible
Colorado’s Public Health Intervention Program (PHIP) helps cover PrEP expenses for anyone living in Colorado who has an income less than 500% of the Federal Poverty Level.
If you have insurance, you must apply for the Gilead copay card to receive the assistance. If you do not have insurance, you must apply for Gilead’s Advancing Access program and see an approved PHIP-PrEP medical provider.
You can apply online or by mail. You must provide the following documents:
- Proof of income (one month's worth of paystubs, award letter, etc.)
- Your insurance card, if applicable
- Gilead Co-Pay Card, if you have insurance
PHIP is not eligible for those with Colorado Medicaid. However, if you have Colorado Medicaid, your PrEP costs should be covered at a $1-3 copay for both medication and related medical services.
The New York State Department of Health’s AIDS Institute has a PrEP assistance program for individuals without insurance. The program covers the cost of PrEP-related medical services including HIV testing, counseling, STI testing, and primary care services. The cost of PrEP itself will be covered through manufacturer-sponsored patient assistance programs, to which healthcare providers affiliated with the program can help you apply.
Washington State’s PrEP Drug Assistance Program (PrEP-DAP) provides financial assistance with PrEP and related medical services.
The program covers the cost of Truvada®. The Washington Department of Public Health contracts with Ramsell Corp® to provide pharmacy benefits for program participants. You must use a pharmacy contracted with Ramsell for PrEP-DAP to receive the financial assistance (Alto is contracted with Ramsell).
In addition, Washington’s PrEP-DAP also covers many of the PrEP-related lab and medical services including baseline and monitoring tests for STIs, kidney function, and Hepatitis B. If you have insurance, the program covers your portion of insurance deductibles, copays, and coinsurance up to a certain limit. To confirm the current maximum amount of financial assistance for individuals with insurance, call 360-236-3412 or 877-376-9316 (toll free) or email PrEPDAP@doh.wa.gov.
If you do not have insurance, the program will cover all of the costs up to the maximum amount of covered services.
To be eligible for Washington’s PrEP-DAP, you must live in Washington State, test negative for HIV, and meet one of several defined risk factors, described in more detail here.
More about PrEP
There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and Emtricitabine 200 mg/Tenofovir 300 mg (generic Truvada, which became available in October 2020). PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.
- Chlamydia, gonorrhea, and syphilis
- Kidney function
- Pregnancy and pregnancy intent
- Hepatitis B and C virus
You will also have to visit a healthcare provider while taking PrEP for follow-up testing including:
- HIV testing every 3 months
- STI testing every 3 to 6 months
- Kidney function every 6 months;
- Pregnancy testing and discussion of pregnancy plans every 3 months
- HBV DNA testing every 6 to 12 months while taking PrEP if you have hepatitis B
We’ll help you get PrEP at the most affordable price
Alto will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. We offer discrete, private packaging and free, same-day delivery along with in-app reminders to stay on track. And our pharmacists — who have deep expertise in many clinical areas, including HIV treatment and prevention — are directly available through phone or within the Alto app to answer any questions.
Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging!
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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