Most people in the United States can get PrEP at no cost through a combination of insurance requirements, federal programs, and manufacturer assistance. The path you take depends on whether you have insurance, what your income looks like, and which form of PrEP you prefer. Here’s how each option works and how to combine them so you pay nothing out of pocket.
If You Have Private Insurance
The Affordable Care Act requires most private health plans to cover PrEP with zero cost-sharing when you use an in-network provider. That means no copay, no coinsurance, and no deductible for the medication itself. This applies because the U.S. Preventive Services Task Force gave PrEP an “A” rating, which triggers mandatory coverage under the ACA’s preventive services rules. The requirement extends to the lab work and clinic visits needed to prescribe and monitor PrEP, not just the pills.
In practice, billing errors happen. If your insurance tries to charge you, ask your provider’s office to confirm the claim was submitted with the correct preventive-service coding. If a copay still appears, Gilead (the maker of Truvada and Descovy) runs a copay assistance program with no income restrictions. It covers remaining out-of-pocket costs for insured patients. You can enroll through your provider or at Gilead’s Advancing Access website.
The Ready, Set, PrEP Program
Ready, Set, PrEP is a federal program that provides PrEP medication at no cost. To qualify, you need to meet three conditions: you lack prescription drug coverage, you’ve tested negative for HIV, and you have a valid PrEP prescription. There are no income limits.
You or your healthcare provider can apply at readysetprep.hiv.gov. Once approved, you pick up your medication at a participating pharmacy. The program covers the medication only, not lab tests or clinic visits. For those costs, you’ll need to layer on other resources (more on that below).
Manufacturer Patient Assistance Programs
Oral PrEP (Truvada or Descovy)
Gilead’s Advancing Access program provides free medication to people who are uninsured or whose insurance has denied coverage. Your household income must be at or below 500% of the federal poverty level, which works out to about $60,300 per year for a single person in most states. You don’t need a Social Security number to apply, and the medication can be shipped to your provider, a pharmacy, or directly to your home. Your prescribing provider will need to complete part of the application, and you’ll be asked to submit proof of income.
Injectable PrEP (Apretude)
If you prefer the injectable form of PrEP (a shot every two months instead of a daily pill), ViiV Healthcare offers a patient assistance program for Apretude. You may qualify if you’re uninsured, meet income eligibility criteria, and live in the U.S., D.C., or Puerto Rico. People on Medicare can also apply if they meet additional requirements. However, the program excludes anyone enrolled in Medicaid, ADAP, or other government-funded health plans. To apply, call 1-844-588-3288.
Covering Lab Tests and Clinic Visits
PrEP requires regular monitoring. Before starting, you’ll need an HIV test, screening for sexually transmitted infections, and (for oral PrEP) a kidney function test. Once you’re on PrEP, you’ll return at least every three months for a repeat HIV test and a new 90-day prescription. STI screening continues for anyone who’s sexually active and showing symptoms.
If you’re uninsured, these visits and labs are often the hidden cost. Several options can eliminate them:
- Community health centers use a sliding-scale fee based on income, meaning visits can cost very little or nothing. You can find one near you at findahealthcenter.hrsa.gov.
- State PrEP assistance programs exist in many states and specifically cover lab work, clinic visits, or both. NASTAD maintains a directory of every state’s program at nastad.org/prepcost-resources/prep-assistance-programs.
- The Patient Advocate Foundation offers copay assistance that can fill gaps left by other programs.
Combining a medication assistance program with a state PrEP assistance program and a community health center is the most reliable way to bring your total cost to zero when you don’t have insurance.
How to Find a Provider
Not every doctor is experienced with PrEP, and some may not know about the assistance programs that make it free. The CDC’s HIV services locator at locator.hiv.gov lets you search by ZIP code for nearby clinics and providers who prescribe PrEP. Many of these sites are already set up to help you enroll in assistance programs during your first visit.
Sexual health clinics, LGBTQ+ health centers, and Planned Parenthood locations also prescribe PrEP and are often familiar with the enrollment process. Telehealth services have expanded access as well, particularly in areas with fewer in-person options.
Putting It All Together
The combination of programs you use depends on your situation, but the general steps are the same:
- Insured with a copay: Your plan should cover PrEP at zero cost. If a copay slips through, enroll in Gilead’s copay card or ViiV’s equivalent for injectable PrEP.
- Uninsured, income under 500% FPL: Apply to the manufacturer’s patient assistance program for free medication. Use a community health center or state PrEP assistance program for labs and visits.
- Uninsured, any income: Apply to Ready, Set, PrEP for medication (no income limit). Pair it with a community health center for clinical care.
Your first appointment will involve an HIV test, bloodwork, and a conversation about which form of PrEP fits your life. From there, you’ll return every three months for oral PrEP or every two months for the injectable. Many clinics handle the assistance program paperwork in-house, so bring proof of income and insurance status (or lack of it) to your first visit, and staff can walk you through the applications on the spot.