Getting a PrEP prescription is straightforward: you need a provider visit (in person or online), a set of lab tests to confirm you’re eligible, and a pharmacy to fill the medication. Most private insurance plans are now required to cover PrEP and all related lab work with zero out-of-pocket cost, and assistance programs exist for people without insurance. Here’s what the process looks like from start to finish.
Where to Get a Prescription
You have three main options for finding a prescribing provider. The first is your regular primary care doctor. Any licensed clinician can prescribe PrEP; you don’t need to see an HIV specialist. If your doctor isn’t familiar with PrEP, they can follow CDC clinical guidelines, but you may find the process smoother with a provider who prescribes it regularly.
The second option is a sexual health clinic. The CDC maintains a location-based search tool at HIV.gov that lets you find HIV prevention services near you, including clinics experienced with PrEP. Community health centers and Planned Parenthood locations also prescribe it in many areas.
The third option is telehealth. Several online platforms now specialize in PrEP prescriptions. The typical process works like this: you create a profile, schedule a video visit with a provider, complete lab testing (often through an at-home kit or a local lab order), and receive your prescription by mail once results are reviewed. Follow-up labs happen every three months, and refills are sent after each round of results clears. You generally need to be 18 or older and living in the U.S. to use these services.
What Happens at Your First Visit
The initial appointment is mostly a conversation and lab orders. Your provider will ask about your sexual history, current partners, and why you’re interested in PrEP. There’s no strict behavioral checklist you need to meet. CDC guidance frames PrEP as appropriate for any sexually active person who could benefit from it, and the conversation is meant to be collaborative, not gatekeeping.
Before writing a prescription, your provider will order several lab tests:
- HIV test: This is the single non-negotiable requirement. You must test negative for HIV before starting PrEP. The test needs to be a blood-based method, not an oral rapid test, because blood tests are more sensitive and better at catching recent infections. If you’ve had symptoms of acute HIV (fever, rash, sore throat, swollen lymph nodes) in the past month, your provider will order additional testing to rule out a very recent infection.
- Kidney function: A blood test measuring creatinine levels is required if you’ll be taking either of the two oral PrEP options. Your provider uses this value to estimate how well your kidneys are filtering. This test is not required for the injectable form.
- STI screening: Tests for chlamydia, gonorrhea, and syphilis are recommended for all patients starting PrEP.
- Hepatitis B: All patients starting oral PrEP must be screened for hepatitis B. Having hepatitis B doesn’t disqualify you from PrEP, but your provider needs to know about it because stopping certain PrEP medications abruptly can cause hepatitis B to flare.
- Cholesterol and triglycerides: Required only if you’re prescribed the Descovy formulation specifically.
In many cases, your provider can send you for labs the same day or even before the visit. Once results come back (typically within a few days), you’ll get your prescription.
Choosing Between the Three PrEP Options
There are currently three FDA-approved PrEP medications, and your provider should let you choose the one that fits your life best. Insurance plans cannot steer you toward one formulation over another.
Truvada (emtricitabine/tenofovir disoproxil fumarate) is the original oral PrEP, taken as one pill daily. It’s approved for all adults at risk of HIV through any type of sex or injection drug use. Generic versions are available, making it the least expensive option.
Descovy (emtricitabine/tenofovir alafenamide) is also a once-daily pill. It uses a newer formulation that’s easier on the kidneys and bones. One important limitation: Descovy is not FDA-approved for people at risk through receptive vaginal sex, so it’s currently indicated for men and transgender women who have sex with men.
Apretude (cabotegravir) is an injectable option approved in late 2021 for anyone 12 and older weighing at least 77 pounds. Instead of taking a daily pill, you get an injection in the buttock from a healthcare provider. The first two shots are given one month apart, then you switch to one shot every two months. The major advantage is that you never have to remember a daily pill. The tradeoff is that you need regular clinic visits for injections, and Apretude is distributed through specialty pharmacies rather than regular retail pharmacies.
What PrEP Costs (and How to Get It Free)
For most people with private health insurance, PrEP should cost nothing. Under an Affordable Care Act requirement that took full effect for plan years starting August 31, 2024, private insurers must cover all three FDA-approved PrEP formulations with zero cost-sharing. That includes the medication itself and all related services: HIV testing, STI screening, hepatitis B testing, kidney function labs, and follow-up visits. If your insurer tries to charge you a copay or requires prior authorization to switch between formulations, that likely violates current federal rules.
If you’re uninsured, the Gilead Advancing Access Patient Assistance Program covers the cost of Truvada or Descovy for eligible individuals. You qualify if your household income is below 500% of the federal poverty level, which works out to about $60,300 per year in most states. The program is available regardless of immigration status. You’ll need to submit proof of income.
The federal Ready, Set, PrEP program is another option that provides PrEP medication at no cost to people without prescription drug coverage. Many states also run their own PrEP assistance programs that can help cover lab work and clinic visits that the drug manufacturer programs don’t.
Keeping Your Prescription Active
PrEP isn’t a one-time prescription. You’ll need follow-up visits roughly every three months for as long as you stay on it. At each visit, you’ll repeat an HIV test (again, a blood-based test, not an oral swab) and get screened for STIs. If you’re on oral PrEP, your kidney function will be rechecked periodically. These follow-up labs and visits are also covered at no cost under the same ACA preventive services rules.
For the injectable option, follow-up is built into your injection schedule since you’re already visiting a provider every two months. Missing injection appointments can leave gaps in protection and makes it harder to restart, so consistent scheduling matters more with this option than with daily pills, which you can simply resume.
How Long It Takes to Get Protected
PrEP doesn’t work instantly. For daily oral PrEP taken for receptive anal sex, maximum protection is generally reached after about 7 days of consistent use. For receptive vaginal sex, it takes about 21 days of daily pills to reach full effectiveness. During this ramp-up period, you should use condoms or other prevention methods. For the injectable form, protection begins after your first injection, but the initial two closely spaced doses are designed to build drug levels quickly.
The most important factor in PrEP’s effectiveness is consistency. Oral PrEP reduces the risk of getting HIV from sex by about 99% when taken daily as prescribed. Missing doses significantly reduces that protection. If daily pill-taking is something you struggle with, the injectable option may be a better fit.