Getting on PrEP is a straightforward process: you need an HIV test, a short medical screening, and a prescription from a healthcare provider. Most people can start within a week or two of their first appointment, and under the Affordable Care Act, private insurance plans must cover PrEP medication and all related lab work with zero out-of-pocket cost. Even without insurance, federal programs can provide the medication for free.
Who Can Get PrEP
PrEP is for anyone who has risk factors for getting HIV, whether through sex or injection drug use. CDC guidelines direct clinicians to offer PrEP to people in any of these situations:
- A sexual partner who has HIV, especially if that partner’s viral load is unknown or detectable
- A bacterial STI (syphilis, gonorrhea, or chlamydia) in the past six months
- Inconsistent or no condom use with partners whose HIV status is unknown
- Sexual activity in a community or network with high HIV rates
- Sharing injection equipment such as needles, syringes, or cookers
You don’t need to check every box. A single risk factor is enough. PrEP is also safe for people who are pregnant or breastfeeding. The only absolute requirement is that you test negative for HIV before starting.
Where to Get a Prescription
You have several options for seeing a provider. Your primary care doctor can prescribe PrEP. So can sexual health clinics, community health centers, and many urgent care providers. If none of those feel convenient or comfortable, telehealth platforms now handle the entire process remotely. You create a profile, schedule a video visit, get lab orders sent to a local lab, and have the medication shipped to your home. Follow-up appointments happen virtually every three months.
If you’re not sure where to start, searching for a PrEP provider through your local health department or visiting GetYourPrEP.com can point you to nearby options.
What Happens at Your First Visit
The initial appointment is mostly about lab work. Your provider will order a set of baseline tests before writing a prescription:
- HIV test: You must have a documented negative result within seven days of starting PrEP.
- STI screening: Tests for chlamydia, gonorrhea, and syphilis.
- Kidney function: A blood test to make sure your kidneys can safely process the medication. This is required for the pill forms but not for the injectable option.
- Hepatitis B screening: Having hepatitis B doesn’t disqualify you, but your provider needs to know about it because the medications in PrEP also affect the hepatitis B virus. If you’re not immune, vaccination is recommended.
If you’re prescribed one specific pill form, a cholesterol and triglyceride check may also be done. Results typically come back within a few days, and once everything looks clear, your provider sends the prescription to a pharmacy.
Choosing Between Pills and Injections
Three FDA-approved PrEP options exist, and they differ in who they’re approved for and how you take them.
Truvada (generic available) is a daily pill approved for all people at risk for HIV through sex or injection drug use. It’s the most widely prescribed option and has the longest track record. Generic versions have made it significantly cheaper.
Descovy is also a daily pill, but it’s approved only for men and transgender women who have sex. It is not approved for people at risk through receptive vaginal sex, because it hasn’t been studied in that population. Descovy is easier on the kidneys, so it’s an option for people whose kidney function falls in a lower range.
Apretude is an injection given in the buttock by a healthcare provider. Instead of daily pills, you get a shot once a month for the first two months, then every two months after that, totaling about six clinic visits per year. It’s approved for adults and adolescents weighing at least 77 pounds who are at risk through sex. Because it’s an injection, kidney monitoring isn’t required.
Your provider can help you decide which option fits your lifestyle. If remembering a daily pill feels unreliable, the injection removes that variable entirely. If you prefer handling things on your own without regular clinic visits, a daily pill may be simpler.
On-Demand Dosing for Some Men
If you don’t have sex frequently enough to justify a daily pill, there’s an alternative dosing schedule called “2-1-1” that has been studied in gay and bisexual men for anal sex. You take two pills 2 to 24 hours before sex, one pill 24 hours after the first dose, and one more pill 24 hours after the second dose. This event-driven approach provides effective protection while using far fewer pills. It’s worth discussing with your provider if your sexual activity is occasional rather than regular.
How to Cover the Cost
Most people pay nothing. The Affordable Care Act requires non-grandfathered private insurance plans to cover PrEP medication and all related services, including lab tests, clinic visits, and adherence counseling, with no copay, deductible, or coinsurance. Plans cannot use management techniques to limit access to these services.
If you don’t have insurance that covers prescriptions, the federal Ready, Set, PrEP program provides PrEP medication at no cost. To qualify, you need a negative HIV test, a valid prescription, and no prescription drug coverage. You can apply online at GetYourPrEP.com, call 855-447-8410, or enroll in person at a community health center. You pick up the medication at a pharmacy of your choice.
The manufacturer Gilead also runs a patient support program called Advancing Access for people prescribed its HIV prevention medications. You and your doctor fill out an enrollment form, fax it in or call 1-800-226-2056, and the program connects you with financial support options. People who use federally operated Indian Health Service clinics can also receive PrEP at no charge regardless of other eligibility.
What to Expect After You Start
PrEP requires ongoing monitoring. Every three months, you’ll need to repeat your HIV test and STI screenings. Your provider will also check kidney function periodically if you’re on a pill form. These follow-up visits are straightforward, often just a lab draw and a brief check-in, and they’re covered without cost sharing under the same ACA rules that cover the medication itself.
Some people experience mild side effects when they first start oral PrEP, most commonly nausea, headache, or fatigue. These typically fade within the first few weeks. PrEP doesn’t protect against other STIs, so many providers will discuss condom use and other prevention strategies as part of your ongoing care.
Daily PrEP reaches maximum protection at different speeds depending on the type of exposure. For receptive anal sex, it takes about seven days of daily use. For receptive vaginal sex or injection drug use, it takes about 21 days. Your provider will explain what to do for protection during that initial window.