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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.

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.

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:

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. 

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 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:

Have a negative HIV test dated within six months of the PrEP-AP application

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.)

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.

Eligibility is based on financial and medical need. Learn more about how to apply and search for a New York State PrEP-AP provider near you.

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.

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.

A negative HIV test is required before starting PrEP. Your doctor or pharmacist may also recommend additional tests to ensure that it’s safe for you to use PrEP. Initial baseline testing may include:

You will also have to visit a healthcare provider while taking PrEP for follow-up testing including:

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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Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable.

Prioritize Your Health with Preventative Care

If you’ve ever waited until you’re sick to see a doctor, you’re not alone. Many adults in the U.S. put off routine doctor’s appointments — sometimes even when they don’t feel well. 

These delays can be serious: according to the Centers for Disease Control and Prevention, up to 40% of all fatalities linked to the five leading causes of death in the U.S. — heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries — could have been prevented. Untreated blood pressure or cholesterol and unhealthy lifestyle habits factors heavily into many of these cases.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable. Preventative care involves a combination of annual check-ups, vaccinations, screenings, and healthy lifestyle habits. 

If you haven’t been to the doctor in a while, don’t get discouraged. The important thing is to get back in the habit. Below is an overview of preventative care for both men and women, with recommendations from our pharmacists for how to ensure you’re prioritizing your health.

There are several important numbers that help your doctor understand your risk for health conditions such as heart disease and diabetes: your body mass index (BMI), blood pressure, cholesterol, and glucose levels.

Being overweight or obese increases your risk for many different health conditions, including high blood pressure, unhealthy cholesterol levels, type 2 diabetes, heart disease, and stroke. 

Body mass index (BMI) is a screening tool that doctors use for obesity. A healthy BMI is typically between 18.5 to 24.9, while a BMI between 25 to 29.9 is considered overweight and a BMI of 30 or higher is obese.

Keep in mind that while a BMI does help doctors understand your general risk for the chronic conditions mentioned above, it is merely a snapshot of your health and doesn’t account for other important health factors including age and genetics. Your healthcare provider can help you understand your overall priorities with preventative care beyond any single number, which is another important reason to stay up to date with doctor’s appointments.

Your blood pressure numbers are one of several factors that can help your doctor predict your risk for heart disease and cardiac events like a heart attack or stroke. There are five different blood pressure ranges recognized by the American Heart Association:

If your blood pressure is in the normal range, you should get screened at least once per year. If your blood pressure is in a higher range, consult with your doctor about recommended screening frequency.

Read our previous blog to learn more about managing blood pressure.

A cholesterol blood test, also called a lipid profile or lipid panel, gives results for several different readings: HDL (good) cholesterol, LDL (bad) cholesterol, triglycerides, and total blood (or serum) cholesterol. Your total cholesterol and HDL cholesterol levels are particularly important in helping your doctor identify if you are at risk for a heart attack or stroke.

A healthy range for total cholesterol is considered to be less than 200 mg/dL

A healthy range for HDL cholesterol is considered to be higher than 40 mg/dL for men and higher than 50 mg/dL for women

A healthy range for LDL cholesterol is considered to be less than 100 mg/dL

These targets are intended to be general guidelines, and each individual’s health needs are different. Having type 2 diabetes, smoking, being overweight, and not getting enough physical activity can affect your cholesterol levels. Your healthcare provider can help you determine your personal targets.

If your total cholesterol is under 200 mg/dL, you can have your cholesterol checked every 4-6 years. If you are at higher risk for heart disease and stroke, consult your doctor about recommended screening frequency.

Your blood glucose numbers can help your doctor determine if you have diabetes or are at risk for developing it. A blood sugar level under 140 mg/dL (7.8 mmol/L) is typical considered healthy, while a reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) may indicate prediabetes and a reading over 200 mg/dL may indicate diabetes. A discussion of these numbers with your healthcare provider is required for an official diagnosis of diabetes.

Generally speaking, if your blood glucose numbers are under 140 mg/dL, you should get screened at least every three years. If you have prediabetes you will need more frequent screening.

If you have diabetes, your healthcare provider can help you develop individualized targets for healthy blood sugar levels, which may be different from the numbers above. Try not to worry about what “normal” looks like for other people, and focus instead on taking simple actions to control your diabetes and live your healthiest life, like staying active and quitting unhealthy habits.

You should have an annual check-up once per calendar year. This appointment is the foundation of preventative care: since each individual’s risk for specific preventable health conditions may vary, discussing your personal health history and vital signs with your doctor will help you determine which preventative measures to prioritize.

In addition to checking with your physician about which vaccines, screenings, and medical tests you need, ask if your family history indicates an increased risk for any health conditions.

Prevention and screening become more important as you age. Regular colorectal cancer screening is recommended for everyone 50 and over. If you have risk factors like an immediate family member with colorectal cancer, your doctor may suggest earlier screening.

The American Cancer Society recommends annual mammograms for all women between 45 and 54. Some women begin screening for breast cancer as early as age 40 depending on their risk and family history. Women 55 and older can continue with yearly mammograms or switch to every two years. Your doctor can help you determine the right screening frequency for your individual needs. 

Preventative health doesn’t just happen in your doctor’s office. Everyday choices like what you eat and how often you exercise can protect your health for years to come.

Staying active is one of the most important things you can do to prevent cardiovascular disease and maintain a healthy weight. If you’re just starting to figure out your ideal exercise routine, know that you don’t have to exert yourself too hard to reap the benefits of physical activity. Even just 30 minutes of moderate exercise most days of the week can help strengthen your heart.

Everyone should do their best to limit their intake of the following foods, but it’s especially important if you face a greater risk for heart disease or diabetes:

Saturated and trans fats, which can raise your cholesterol

Sodium, which may increase your blood pressure

Sweets and sugar-sweetened beverages, which have been linked to both type 2 diabetes and an increased risk for heart disease

Other things you can do to stay healthy? Chronic stress can elevate your blood pressure, putting you at a greater risk for heart attack and stroke, so try to manage stress in heart-healthy ways like getting enough sleep, maintaining a fulfilling social life, and practicing mindfulness and gratitude. And it’s never a bad time to cut back on your alcohol consumption and quit smoking, if you currently smoke.

Prioritizing your physical and mental well-being today can help you prevent health issues in the future. We’re here to help make that as simple as possible.

At Alto, a pharmacist is your partner in health. If you take medication, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. And our team of patient care pharmacists is available to chat whenever questions come up. Reach out through our in-app messaging or by phone at 1-800-874-5881.

The U.S. Centers for Disease Control and Prevention (CDC) has updated its guidelines for PrEP, a medication that can lower risk of sexual transmission of HIV by 99% when taken daily. The new guidelines — which will inform local healthcare policies and doctors’ decision-making processes — recommend that healthcare providers share information about PrEP with any patient who is sexually active, and that they prescribe PrEP for any patient who requests it. Here’s what to expect from the changes.

How Updated CDC Guidelines Can Expand PrEP Access

PrEP usage has historically been low despite the medication’s effectiveness. In 2020, just 25% of those who could benefit from PrEP were taking it.

Under the former guidelines, many doctors only shared information about PrEP with patients who presently have multiple partners or a partner who is HIV-positive or unsure of their HIV status. In reality, more people could benefit from PrEP, including those who are single and sexually active.

Under the new guidelines, anyone who is sexually active should receive PrEP information from their healthcare provider, including adolescents. Given that many traditional sex education programs in schools throughout the U.S. aren’t providing LGBTQIA+ youth with the resources they need to stay safe and healthy, the new guidelines are also an important step toward more inclusive sexual education.

Opening up the conversation about HIV prevention to more individuals aligns with what Dr. Lisa Sterman, MD, MPH, shared during a conversation with Alto in October 2020.

“A lot of people may think, ‘I’m not at risk’ or, ‘that’s not my group of people,’” Sterman said. “The way I teach it is: if you’ve ever had sex, you’re at risk for HIV. If you’ve ever shared drug needles, you’re at risk for HIV. Everyone should know their status.”

Addressing fear of discrimination or stigma at the doctor’s office

Previously, many individuals were asked to disclose personal information about their sexual health or drug use in order to receive a PrEP prescription. However, many people at risk of contracting HIV don’t feel like they can speak openly with their healthcare providers, particularly LGBTQIA+ people of color, who face multiple forms of discrimination. This barrier to PrEP access has kept many individuals from starting the medication and contributed to racial disparities in HIV rates: according to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

The new guidelines aim to make PrEP more accessible for those who may be reluctant to share information about potentially stigmatized behavior with their healthcare providers. While conversations between doctors and patients about PrEP may initially cover a patient’s sexual health history, the CDC has recommended that anyone should receive a prescription for PrEP if requested.

There are more FDA-approved medication options for PrEP than ever before: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. The following resources can connect you with a provider who will prescribe PrEP for you:

Alto will coordinate with your doctor and your insurance provider, if applicable, to ensure you’re receiving the best PrEP option for your needs at the best price. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

Editor’s Note: This post was originally published in July 2021 and has been updated for accuracy and completeness.

What Updated CDC Guidelines Mean for PrEP Access

Given how accessible pharmacies are in many communities, there’s growing recognition that expanding the role of pharmacists in HIV prevention can help increase PrEP usage. Here’s a high-level overview of the process for getting PrEP from a pharmacy without a doctor’s prescription.

PrEP, or pre-exposure prophylaxis, has tremendous potential to save lives: the HIV prevention medication can lower risk of sexual transmission by 99% when taken daily. But ever since PrEP was first approved by the FDA in 2012, barriers like affordability, lack of access to healthcare systems, and fear of stigma have contributed to low usage rates. According to the American Journal of Public Health, fewer than 10% of people who could benefit from PrEP are taking it.

For many people at risk of contracting HIV, getting PrEP from a primary care provider isn’t an option. They may live far from a doctor, or they may not have a doctor they’re comfortable speaking with about their sexual health. Pharmacists have an opportunity to fill a critical need in expanding access to PrEP, as most people visit a pharmacy 35 times a year on average, and more than 90% of people in the U.S. live within five miles of one. 

Given how accessible pharmacies are in many communities, there’s growing recognition that expanding the role of pharmacists in HIV prevention can help increase PrEP usage. California became the first state to allow pharmacists to prescribe PrEP in 2019, and Colorado became the second in November 2020. Nevada passed a law in June, expected to be implemented in the near future, that will allow pharmacists to prescribe PrEP and provide related services including HIV testing. A handful of other states now have similar legislation underway.

Getting PrEP from a pharmacy under the new laws

If you live in a state with expanded PrEP access, here’s a high-level overview of the process for getting PrEP from a pharmacy without a doctor’s prescription.

A negative HIV test and baseline testing for sexually transmitted infections, hepatitis B, and kidney disease are required to start PrEP. Under the new guidelines, your pharmacy can order the lab work directly through your insurance. If it’s safe for you to start PrEP based on the lab results, your pharmacist will contact you for a consultation to discuss usage and side effects and answer any questions you have.

Most of the legislation limits pharmacist-prescribed PrEP to a 60 or 90-day supply. After that, you will need a doctor’s prescription to continue with PrEP. Check local guidelines for the latest information in your state. The following resources can connect you with a provider who will prescribe PrEP:

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and a generic for 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.

In addition to the initial baseline testing, you will also have to visit a healthcare provider for follow-up testing while taking PrEP, including:

Sexually transmitted infection testing every 3 to 6 months

PrEP is now more accessible and affordable than ever, no matter which state you live in. Excited? We are, too! 

We 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. In addition to our AAHIVP-certified pharmacist team, you can expect:

Discrete, private packaging and free, same-day delivery

Med syncing support and in-app reminders to stay on track

Pharmacists directly available through phone or within the Alto app

Editor’s Note: This post was originally published in July 2021 and has been updated for accuracy and completeness.

Expanded PrEP Access at Pharmacies: What to Know

Learn more about the United State Preventative Service Task Force’s Grade "A" recommendation and what it means for your access to PrEP.

What a USPSTF “A” Recommendation Means for PrEP Access

With a Grade A recommendation from the US Preventive Services Task Force (USPSTF), PrEP — an HIV prevention medication that can lower risk of sexual transmission by 99% when taken daily — is now more accessible than ever. Under the Affordable Care Act, most private insurance plans must cover preventive services with an “A” or “B” recommendation from the USPSTF without copays or deductibles. This means that at least one PrEP option will be available at no cost to qualifying individuals on these plans. 

PrEP’s 2019 Grade A recommendation from the USPSTF was implemented this year. Below, we explain more about the Task Force’s recommendation and what it means for your access to PrEP.

The Importance of Preventive Services and the USPSTF

Preventive care — including medications like PrEP, cancer screenings, immunizations, and more — saves lives. These services can prevent serious diseases or detect them early on, when they are more treatable. It’s critical that doctors understand the effectiveness of these screenings and treatments, and the US Preventive Services Task Force was created to fill that need.

The USPSTF is an independent group of prevention experts whose evidence-based evaluations help healthcare providers make informed recommendations for their patients. The Task Force’s membership has expertise in a range of specialties under the umbrella of primary care and preventive medicine, including internal medicine, behavioral health, obstetrics and gynecology, and more. They assign each recommendation an A, B, C, or D grade or an I statement. Here’s what each recommendation means:

“A” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is substantial.

“B” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

“C” Recommendation: Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.

“D” Recommendation: The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

“I” Statement: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Since preventive services are recommended based on a person’s level of risk for a specific disease or condition, there is variation in individual preventive needs. Your primary care provider will recommend screenings and medications depending upon factors like your family history, age, current health status, and more.

With PrEP, the “A” rating and related insurance coverage applies to individuals who are HIV-negative but at high risk of getting HIV from contracting the virus. That includes:

People whose partner is HIV-positive or unsure of their HIV status

The Affordable Care Act and USPSTF Recommendations

Millions of people in the US don’t receive critical, and often life-saving, preventive services. For many, cost is a big barrier. A 2020 study found that 1 in 3 US families postponed medical care services because of the financial strain. And according to the American Journal of Public Health, in the case of PrEP, fewer than 10% of people who could benefit from the medication are taking it.

The Affordable Care Act provision requiring private insurers to cover Grade “A” and “B” preventive services without copays or deductibles was designed to alleviate this financial burden. The Center for Consumer Information and Insurance Oversight (CCIIO) oversees the implementation of law provisions related to private health insurance, and private insurers have a responsibility to monitor USPSTF recommendations and remain compliant with requirements.

While the new provision is a big step forward for HIV prevention, getting the specific brand of PrEP medication you need may require some additional legwork.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. Truvada and Descovy are both effective at preventing HIV, but they are not identical. Some people may need one version over the other due to preexisting health issues. However, the ACA’s provision only requires health plans to cover at least one of the available PrEP options without copays or deductibles.

Government plans including Medicaid typically cover brand-name PrEP medication while most private insurance companies will cover generic PrEP. If your doctor has prescribed a specific brand of PrEP medication not covered by your insurance, a request for coverage may be required. 

This is called a prior authorization. Alto’s dedicated support team can help you understand the details of your insurance plan and will coordinate closely with your doctor’s office on filing prior authorizations to help you get the medication you need. Call us directly at 1-800-874-5881 to confirm coverage.

Too often, preventive services are inaccessible to those without insurance. Thankfully, patient assistance programs for PrEP help make the medication more affordable for those who are uninsured. For example, Truvada’s manufacturer, Gilead, has a Medical Assistance Program for people without insurance, in addition to a copay card for those with insurance.

Alto will automatically conduct a thorough price investigation to identify these potential sources of financial assistance and ensure you're getting the lowest possible price. We also carry a generic PrEP option that currently runs at $36.60 a month out of pocket.*

Read more about PrEP access and affordability.

Get the PrEP medication you need at the best possible price

Getting PrEP at the most affordable price shouldn’t be a hassle. At Alto, our team will do the research for you and coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option. Our pharmacists have deep expertise in many clinical areas, including patients living with HIV, and those taking PrEP, PEP and HRT medications.

Adherence support with pharmacist lab reminders

Pharmacists directly available through phone or within the Alto app  

We’re hard at work the moment we receive your prescription, handling insurance and prior authorizations, as well as making sure you get your medicine, at the best price, delivered at no additional cost. Reach out any time to get started via phone at 1-800-874-5881 or in-app messaging.

Here’s a quick overview on PrEP access and affordability in light of recent updates.

Getting PrEP for HIV prevention at an affordable cost

Pre-exposure prophylaxis (PrEP) is a medicine that prevents people who are HIV-negative but at high risk of getting HIV from contracting the virus. If you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners, PrEP may be right for you. It also reduces HIV risk in those using intravenous drugs. If taken daily, it lowers the risk of getting HIV from sex and intravenous drug use by about 99% and 74%, respectively.

Cost can be a barrier to starting PrEP, but the life-saving medication is now more accessible than ever, thanks to the recent arrival of generic options and changes to private insurance coverage. Still, given the complexities of navigating healthcare, getting PrEP at the best cost may require a bit of legwork and some familiarity with the landscape. Here’s a quick overview on PrEP access and affordability in light of the recent updates.

There are two FDA-approved medications for PrEP: Truvada® and Descovy®. A generic for Truvada called Emtricitabine/Tenofovir disoproxil fumarate became available in October 2020. 

In general, as more generic options become available, the additional competition typically drives down the price of all options, which is already the case with generic Truvada: a 30-day supply of the brand-name version comes out to $1600-1800, while Alto carries a generic option that currently runs at $36.60 a month out of pocket.

Given that generic medications can cost 85% less than their brand-name equivalents, it’s understandable to wonder if the cost disparity is a reflection of quality. Rest assured that generic Truvada is therapeutically equivalent to the brand-name version: generic medications use the same active ingredients as their brand-name counterparts, and they must meet the same standards for safety, quality, and results in order to get FDA approval.

Read the difference between generic and brand-name medications.

Patient Assistance Programs for Brand-Name PrEP

Despite the equivalent nature of generic and brand-name PrEP, your doctor may choose to prescribe a brand version instead of a generic option for various reasons. If that’s the case, there are resources to help reduce the cost of brand-name PrEP. Patient assistance programs have helped many people access these medications at a low cost or even for free. 

For example, Gilead, the manufacturer of brand-name Truvada, has the Gilead Advancing Access® program, which offers a copay card for those with insurance and a Medical Assistance Program for those who are uninsured. Alto will automatically conduct a thorough price investigation to identify these potential sources of financial assistance and ensure you're getting the lowest possible price.

Most private insurers are now required to cover at least one PrEP option

As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. PrEP has received an “A” recommendation from the U.S. Preventive Services Task force, and as such, it must be covered by most private health insurance plans without copays or deductibles.

However, getting approval for a specific brand of PrEP medication may require some additional legwork. The law requires health plans to cover at least one of the available PrEP options without copays or deductibles. That means if your private insurer covers the generic version of Truvada but you need the brand-name version — or vice versa — you’ll need to go through an additional approval process called a prior authorization. This is a request to your insurance company for coverage of certain medications.

After the arrival of generic Truvada, several insurance companies have decided to stop covering Descovy. While these two forms of PrEP are both effective at preventing HIV, they are not identical. Some people may need one version over the other for preexisting health issues. In these cases, you may need prior authorization approval and could potentially face higher out-of-pocket costs. Alto’s dedicated support team will coordinate closely with your doctor’s office on filing prior authorizations to avoid delays with starting PrEP.

Check your formulary for a breakdown of your plan’s PrEP coverage

Every health insurance plan has a list of covered drugs, called a formulary, which you can locate online or by calling your plan. This is where you can find details about which PrEP medications your plan covers. If a medication isn’t on your “open” formulary, you may have the option of submitting a prior authorization. On the other hand, if you have a “closed” formulary, a prior authorization won’t be approved. Your pharmacy can let you know about your options and whether you have an “open” or “closed” formulary.

One thing to be mindful of is that formularies can change as part of insurance renewals every year. When this happens, an insurance plan can request you to switch from one brand to another, or to a generic version. You may want to ask your healthcare provider if there’s a cheaper version of your medication available. If you fill your prescription with Alto, we’ll do the investigating for you and keep you updated on your best options.

Read our previous post on insurance changes to look out for when renewing your plan.

Get the medication you need without delay

At Alto, we believe that financial wellness plays an important role in your overall well-being. We go above and beyond to ensure that we’re providing the most affordable option, so that you can stay on track with the plan your doctor recommends. We’re here to help you understand which PrEP options your insurance covers, and we’ll do the legwork to make sure you get the lowest possible price.

Switch to a better pharmacy for insurance support, price investigations, and same-day delivery. Feel free to reach out any time via phone at 1-800-874-5881 or in-app messaging.

Getting PrEP for HIV Prevention at an Affordable Cost

Here’s what we know so far about the risk of COVID-19 for people with HIV, vaccine safety, and how to protect yourself from contracting COVID-19. 

What the COVID-19 Vaccine Means for Those With HIV

As of March, 2021, over 115 million people worldwide have been diagnosed with COVID-19. As the COVID-19 pandemic persists, many are wondering what the COVID-19 vaccine could mean for the 38 million people who are living with HIV: is it safe or does it pose a greater risk for these individuals? Here’s what we know so far about the risk of COVID-19 for people with HIV, vaccine safety, and how to protect yourself from contracting COVID-19. 

Are people living with HIV at a higher risk for COVID-19? 

Data is limited and experts are still learning exactly how COVID-19 affects those with HIV, but the Centers for Disease Control and Prevention (CDC) says that those who have HIV (and who are also on effective HIV treatment) generally have the same risk of contracting the virus as those who don’t have HIV. 

So, who is at greater risk? The CDC has evidence that shows older adults and people with certain underlying medical conditions like chronic obstructive pulmonary disease (COPD), type 2 diabetes, and a weakened immune system are at an increased risk for more severe cases of COVID-19. And since nearly half of those living with HIV in the United States are over 50 years old, those living with HIV are encouraged to follow all CDC guidelines to reduce the risk of COVID-19 exposure.

Experts have not found any significant evidence that those living with HIV will experience more severe COVID-19 outcomes; studies performed in Spain and in the United States on a Veterans aging cohort both found no difference in susceptibility to the virus in those with HIV.

Are COVID-19 vaccines safe for people living with HIV?

Yes. According to the United Nations Program on HIV/AIDS (UNAIDS), the COVID-19 vaccines currently being developed or approved by regulators are believed to be safe for most people, including those living with HIV. The COVID-19 vaccines, like other vaccines, undergo the same safety tests and are required to meet rigorous standards. 

Regulators have not yet found any evidence that people living with HIV are at a greater risk from the COVID-19 vaccine in terms of side effects than anyone else.

How does the vaccine work and what symptoms could I expect?

In a recent virtual town hall on COVID-19 and HIV hosted by Getting to Zero San Francisco, experts confirmed that the COVID-19 vaccine has been proven to help reduce the severity of illness from the virus. The vaccine could also prevent infection, reduce transmission, and lead to healthier communities. 

The COVID-19 vaccines work by helping our bodies develop immunity to the virus that causes COVID-19 without us having to actually contract the illness. The different vaccines work in slightly different ways to protect us, but all generally leave the body with a supply of cells that remember how to fight the virus in the future.

After receiving the COVID-19 vaccine, the process of building immunity can result in some people experiencing mild symptoms like a sore arm and mild fever or chills in the days following vaccination. If you have any pain or discomfort, you can talk to your doctor or pharmacist about over-the-counter medications.

How can people with HIV protect themselves from COVID-19?

As you’ve likely heard, the best way to keep from getting sick is simply to avoid exposure to the virus. Everyone, including people living with HIV, should keep taking everyday actions like wearing a mask, staying six feet away from those who don’t live with you, and avoiding crowds, to help avoid contracting and spreading COVID-19.

If you have HIV and are taking your HIV medicine, it’s important to continue doing so and follow any advice from your healthcare provider. This will help keep your immune system healthy and ready to fight off any infection. The CDC also recommends lifestyle practices like eating healthy foods, getting at least eight hours of sleep per night, and minimizing stress as much as you can.

If you develop any symptoms that indicate you might have COVID-19, the CDC recommends calling your healthcare provider and getting tested. Most people have mild illness and can recover at home. If you do develop severe symptoms, the CDC recommends you get emergency medical care immediately.

At Alto, we’re committed to ensuring you receive you medications safely and on time throughout the COVID-19 pandemic. Our pharmacy locations are fully stocked and our pharmacists are on hand to answer any questions and provide ongoing access to support and advice. Reach out to our HIV specialty team through secure in-app messaging or phone at 1-800-874-5881. 

In May 2020, a major clinical trial found that injections of long-acting cabotegravir, an antiviral medication, were highly successful at preventing HIV when taken as a form of pre-exposure prophylaxis (PrEP). We take a closer look at the study to find out what’s likely giving cabotegravir the edge and what this means for the future of PrEP.

What We Know about Injectable PrEP for HIV Prevention

The world of HIV prevention is rapidly changing, with many milestones in recent years. PrEP, or pre-exposure prophylaxis, lowers risk of sexual transmission of HIV by 99% when taken daily, and has helped prevent many new infections since it was approved by the FDA in 2012. There are several FDA-approved oral options — Truvada®, Descovy®,  and a generic for Truvada — and as of December 2021, PrEP is now available as an injectable treatment option called cabotegravir (Apretude®).

Learn more about PrEP in All About PrEP for HIV Prevention.

Health experts believe this latest breakthrough could significantly increase PrEP use and adherence, as clinical studies found that cabotegravir resulted in 69% fewer new cases of HIV than Truvada, a daily pill. Read on to learn what this means for the future of PrEP.

Cabotegravir is a long-acting PrEP medication administered by injection every eight weeks. Prior to cabotegravir’s FDA approval, two parallel clinical trials assessed its safety and efficacy: HPTN 083 and HPTN 084. HPTN 083 looked at men who have sex with men (MSM) and transgender women, while HPTN 084 focused on cisgender women.

Each study randomly assigned participants to one of two arms: half were given a placebo injection and daily Truvada, while the other half received long-acting cabotegravir injections and a daily placebo pill. While both forms of HIV prevention medication are safe and effective, injectable cabotegravir was found to be 69% more effective at lowering HIV transmission rates among MSM and trans women and 89% more effective among cisgender women compared to the daily pill.

While the news about injectable PrEP is undoubtedly a reason for excitement, oral PrEP continues to offer highly effective prevention for anyone at risk of HIV infection. When taken as prescribed, Truvada® and Descovy® are highly effective at lowering risk of transmission. (The rate of HIV acquisition in the studies was low overall, providing further proof of Truvada’s well-studied effectiveness.) However, many people find it difficult to remember to take a pill every day, and inconsistent use of oral PrEP can sharply reduce its effectiveness. The addition of a long-acting injectable form of PrEP offers an opportunity to improve adherence among those who have trouble with a daily regimen or simply find an injection every eight weeks preferable. 

As Debra Birnkrant, M.D., director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research, said in December, “This injection, given every two months, will be critical to addressing the HIV epidemic in the U.S., including helping high-risk individuals and certain groups where adherence to daily medication has been a major challenge or not a realistic option.”

Alto is here every step of the way to make it as easy as possible to follow the treatment plan your doctor recommends. Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with oral PrEP. We will coordinate with your doctor and your insurance provider, if applicable, to ensure that you’re receiving the best PrEP option for your needs at the best price, and the Alto app can help you stay on track with tools like reminders and auto refills.

To learn more, reach out any time through Alto’s in-app messaging or phone at 1-800-874-5881.

Editor’s Note: This post was originally published in 2021 and has been updated for accuracy and completeness.

This October, a generic version of Truvada became available in the United States for the first time. In this article we'll explain what these means for PrEP users and how Alto can help.

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