What is PrEP?
Pre‐exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. There is currently only one approved medication for PrEP in the United States (brand name Truvada) which contains two medicines (tenofovir and emtricitabine). When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection. When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by over 90 percent. PrEP is much less effective if it is not taken consistently.
PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. PrEP should be taken on a daily basis and may not reach its full ability to protect against HIV until several weeks after it is begun. People who use PrEP must commit to taking the drug every day and seeing their health care provider for follow‐up every three months.
To learn more about how PrEP works visit http://sfcityclinic.org/services/prep.asp for a video and more information.
Who should consider taking PrEP in San Francisco?
Because 85 percent of new HIV diagnoses in San Francisco occur in gay, bisexual, and other men who have sex with men and transfemales who have sex with men our local recommendations for PrEP focus on these populations. Others at potential risk of HIV infection (people who inject drugs, heterosexuals who are HIV uninfected and have sex with a partner who injects drugs or is living with HIV) may be offered PrEP, depending on their individual risk.
A person could develop drug resistance if they are HIV-positive (and don’t know it) when starting PrEP. In order to minimize the risk of taking PrEP when already HIV infected, individuals planning to initiate PrEP should first get a 4th generation HIV test, a test that is much more sensitive in detecting acute infection (the period of time immediately following HIV infection).
How can you get access to PrEP?
Insured individuals can access PrEP through their primary care provider and insurance. SFDPH is working to provide information about PrEP to patients and their providers. The uninsured can enroll in Healthy San Francisco for access to affordable health care services.
Do health plans and insurance cover PrEP?
Currently Medi-Cal (the state Medicaid Program) and many private health plans covers PrEP. Since individuals have different health plans, it is best to for you or your doctor to call your plan to learn if PrEP is covered and if co-pays are required.
What if you need assistance with paying for the prescription or copays?
Gilead, the company that makes Truvada, has a Medication Assistance Program (MAP) for PrEP. You or your doctor can call them to see if you qualify for assistance. The phone number to Gilead’s MAP is 1‑855‑330-5479.
Does Healthy San Francisco (HSF) cover PrEP?
Yes. Individuals with SFDPH supported medical homes (which include all SFDPH clinics and most community clinics) who are enrolled in HSF can access PrEP and should first speak to their primary care provider. After evaluating the patient for appropriateness of starting PrEP treatment, providers will refer HSF patients directly to the San Francisco General Hospital Patient Assistance Program (PAP) coordinators. The SFGH PAP coordinators will help patients apply to receive free medication from the manufacturer’s MAP. Once enrolled in the program, Gilead will send the medications to SFGH, and the SFGH PAP Coordinators will dispense directly to the patient. For patients who do not qualify for the Gilead program, HSF will cover the cost of the prescription (the patient’s usual co-pay applies).
HSF participants in non-SFDPH supported medical homes such as Kaiser, Brown & Toland, North East Medical Services, Glide Health Services, Sister Mary Philippa Health Center and BAART Community HealthCare; should work with their primary care providers who may be able to assist them with enrollment into the Gilead MAP.