I’ve had to get PrEP in several countries, so here is a cheatsheet. It’s not so easy in every country, especially for immigrants.
United States
- Free under the Affordable Care Act (see page 3 under “Coverage of Pre-Exposure Prophylaxis”)
- Any family doctor can prescribe it.
- Get it at a pharmacy
Netherlands
https://www.mantotman.nl/nl/snel-regelen/prep-tegen-hiv
At the GGD,
- Long waiting lines
- Call your local GGD for appointment https://www.ggd.nl/
- They will ask you questions like top/bottom, condom use, group sex, etc. Answer honestly, but be as risky as possible. Mentioning things like fear of being stealthed can help.
- Insurance might not cover PrEP. No legal mandate AFAIK.
Alternatives are at a family doctor and https://prep-direct.nl/.
Latvia
- Get a referral for an “Infectologist” (infektologs) from your GP (“ģimenes ārsts”)
- Find an infektologist on https://eveselibaspunkts.lv/en. You can also check https://vc4.lv/pakalpojumi/arstnieciba/infektologija/
- Ask the infektologist for PrEP to be compensated. According to the law https://likumi.lv/doc.php?id=147522, HIV infection risk (Z20.6 “Iespēja inficēties un kontakts ar humānā imūndeficīta vīrusu”) should be 100% compensated. See also drug code J05AR03 in the “A saraksts” https://www.vmnvd.gov.lv/lv/kompensejamo-zalu-saraksti.
- After the infektologist prescribes it, your GP can renew the prescription.
Estonia
Currently figuring this out, so below might be wrong
- Get an appointment with an infektologist
Other countries?
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Fun fact- HIV PREP absolutely is free under the ACA, but nearly all insurance companies in the US actively defy regulation by making up ways not to cover it (which still aren’t in line with the law). Excuses like:
-We need you to use a specific medication -We’ll only cover it if you go to a specific pharmacy -It’s not on our formulary -We can only cover 60% -Oh but there are patient assistance programs! Why don’t you use those instead? We’ll help you get set up with one!
All of these are serious ACA violations and need to be treated as such. If your insurance does this, get in touch with your state’s department of insurance and file a complaint. I did this and had PREP for free within days after nearly a year of fighting.
lol. I love how fast stuff happens when you start reporting people.
Do you have any info about when ACA demands full coverage? I only see "almost"s and "mostly"s like here https://www.cdc.gov/hiv/basics/prep/paying-for-prep/index.html
I do! Here ya go fam- it’s part 47 of the ACA!
Awesome thanks!
On June 11, 2019, the USPSTF released a recommendation with an “A” rating that clinicians offer PrEP with “effective antiretroviral therapy to persons who are at high risk of human immunodeficiency virus (HIV) acquisition.” Accordingly, plans and issuers must cover PrEP consistent with the USPSTF recommendation without cost sharing for plan years (in the individual market, policy years) beginning on or after one year from the issue date of the recommendation (in this case, plan or policy years beginning on or after June 30, 2020).
