PrEP Assistance Program (PrEP-AP) Benefits
Clients without insurance are eligible to receive Truvada® free of charge from Gilead's Patient Assistance Program. The PrEP-AP will only provide assistance with PrEP-related medical costs, and all other medication on the PrEP-AP formulary for the prevention of HIV and treatment of sexually transmitted infections (STIs)
Please Note: Uninsured clients must receive PrEP-related medical services at approved locations within OA's PrEP-AP Provider Network.
Clients with Private Insurance
Clients with private health insurance are eligible for PrEP medication co-payment assistance of $7,200 per calendar year through Gilead's Co-Payment Assistance Program. After this threshold has been met, the PrEP-AP will provide wrap-around coverage for any remaining PrEP medication co-payments for the remainder of calendar the year. Insured clients can enroll in Gilead's Co-Payment Assistance Program online or through an authorized ADAP Enrollment Site. The PrEP-AP will also provide assistance with PrEP-related medical out-of-pockets costs for insured clients and all other medication on the PrEP-AP formulary for the prevention of HIV and treatment of STIs.
Clients with Medicare
Clients with prescription drug coverage through Medicare are not eligible for assistance from Gilead, but are eligible to enroll in the PrEP-AP for co-payment assistance for all medication on the PrEP-AP formulary, including Truvada®.
Medicare clients without prescription drug coverage are eligible to enroll in the Gilead PAP to receive Truvada® free of charge. The PrEP-AP will provide assistance with all other medications on the PrEP-AP formulary.
Please Note: All Medicare clients with outpatient coverage through Medicare are eligible to receive assistance with PrEP-related medical out-of-pocket costs.
PrEP-AP Medical Out-of-Pocket Benefit
Eligible clients may have their PrEP-related medical out-of-pocket costs paid for by the PrEP-AP. Clients must maintain program eligibility in order to qualify for this benefit. Uninsured clients must receive services at approved locations within the PrEP-AP Provider Network and must enroll in the PrEP-AP prior to seeing a contracted provider. Uninsured individuals should reference the PrEP-AP Enrollment Sites /Clinical Network Provider Locator to find contracted clinical providers in the PrEP-AP Provider Network.
Individuals with private insurance or Medicare are required to see a medical provider in their health plan provider network.
Services covered under the medical out-of-pocket benefit are limited to a specific set of allowable PrEP-related billing and diagnosis codes and encompass all services recommended by the Centers for Disease Control and Prevention in the PrEP Clinical Practice Guidelines, including:
- New/established patient office visit for assessment of PrEP
- HIV Testing
- STI Testing
- Pregnancy Testing
- Renal Function Testing
- Hepatitis A Screening
- Hepatitis B Screening
- Hepatitis C Screening
For a complete list of acceptable PrEP-AP related services organized by allowable billing/diagnosis codes please visit the PrEP-AP Resources Page.
All eligible PrEP-AP clients will receive a client identification (ID) card from the PrEP-AP's Medical Benefits Manager; Pool Administrator's Inc. (PAI). This ID card must be presented during your PrEP-related medical visit to ensure you are not charged at the point of service.
For questions about the PrEP-related medical out-of-pocket benefit, please call PAI Monday through Friday from 8:00 a.m. to 5:00 p.m. at (877) 495-0990.
* CDPH, Office of AIDS is charged with coordinating state programs, services, and activities relating to HIV/AIDS and operates PrEP-AP in accordance with these duties. It is not affiliated with, and does not endorse, nor is it endorsed by Gilead Sciences, Inc., or its products.