People who are HIV-negative and vulnerable to HIV infection can take a medication to help prevent HIV. Currently, only one medication, Truvada, is approved by the U.S. Food and Drug Administration (FDA) for the prevention of HIV. It is also recommended by the U.S. Centers for Disease Control and Prevention and the Chicago and Illinois Departments of Public Health.
The AIDS Foundation of Chicago has prepared its Illinois PrEP Marketplace Assessment to help consumers anticipate the monthly out-of-pocket cost a person can expect to pay for Truvada under each of the plans on the Illinois health insurance marketplace. Premiums listed in this document are examples only, based on coverage for a single, 30-year old individual.
Reports of insurance companies denying coverage of Truvada as PrEP are rare and can always be appealed, but it is important to remember that coverage levels vary across companies and plans. Please bear in mind that insurance companies can change their formulary and coverage at any time. Always verify medication coverage directly with a plan before enrolling. All coverage information was accessed between Nov. 1 and Nov. 22, 2016, using the marketplace website (healthcare.gov), the health insurance companies’ websites and calls to insurance companies’ customer service representatives.
Coinsurance costs are based on the average wholesale price of Truvada of about $1,760 per month, as listed in AIDSinfo.gov’s Clinical Guidelines for Antiretroviral Medications. Consumers should strongly consider selecting a plan that requires a copay rather than coinsurance. A copay is a fixed and predictable amount of money and is typically considerably less expensive than coinsurance when applied to a medication as costly as Truvada.
When choosing a plan, consider how much it will cost to visit your health care provider four times a year for HIV and STI testing and lab work, as recommended by medical guidelines for people who take PrEP. Make sure your provider of choice is in the health plan’s network to save the most money.
