Getting PrEP is straightforward: you need an HIV test, a few basic lab results, and a prescription from any licensed healthcare provider. Current CDC guidelines recommend that providers prescribe PrEP to anyone who asks for it, even if you don’t report specific HIV risk factors. The entire process, from first appointment to filling your prescription, typically takes one to two visits.
Who Can Get PrEP
Almost any sexually active adult or adolescent qualifies. The CDC’s current guidance is remarkably broad: providers should inform all sexually active patients about PrEP and prescribe it to anyone who requests it. You don’t need to prove you’re “high risk” or justify your reasons.
PrEP is specifically recommended if any of the following apply to you:
- You have a sexual partner with HIV, especially if their viral load is unknown or not fully suppressed
- You haven’t consistently used condoms during anal or vaginal sex in the past six months
- You’ve been diagnosed with a sexually transmitted infection in the past six months
- You inject drugs and share needles, syringes, or other equipment
- You’ve been prescribed PEP (the emergency medication taken after a potential exposure) and still have ongoing risk
Adolescents weighing at least 77 pounds are eligible. Transgender and nonbinary people using gender-affirming hormones can safely take PrEP, as there are no known drug interactions between PrEP and hormone therapy. People who are pregnant or breastfeeding can use the Truvada formulation, which is considered generally safe during pregnancy.
The only people who cannot take PrEP are those who already have HIV, those with severe kidney impairment (for the pill forms), or those with a known allergic reaction to the injectable version.
Three Types of PrEP Available
There are now three FDA-approved PrEP options, including two daily pills and one injection.
Truvada (tenofovir DF/emtricitabine) is a once-daily pill and the longest-established option. It’s approved for all adults and adolescents regardless of sex or gender. Truvada also has an off-label “on-demand” dosing option for men who have sex with men: you take two pills 2 to 24 hours before sex, one pill 24 hours after that first dose, and one more pill 48 hours after the first dose. If sexual activity continues beyond that window, you keep taking one pill daily until two doses have been taken after the last encounter.
Descovy (tenofovir alafenamide/emtricitabine) is also a once-daily pill. It uses a newer formulation of one of the active ingredients that may be easier on the kidneys and bones. On-demand dosing has not been adequately studied for Descovy, so it’s only recommended as a daily pill.
Apretude (cabotegravir) is an injection given in the gluteal muscle every two months, after two initial monthly doses. If you prefer not to take a daily pill, this is the option to ask about. Your provider may offer a one-month trial of an oral version first to make sure you tolerate it well before committing to injections.
What Happens at Your First Appointment
Before writing a prescription, your provider will order a short list of tests. The most important is an HIV test, since PrEP is only for people who are HIV-negative. Taking PrEP while unknowingly HIV-positive could lead to drug resistance, making future HIV treatment harder.
Beyond the HIV test, expect the following:
- Kidney function test: Required for either oral pill (Truvada or Descovy), but not needed for the injectable
- Hepatitis B screening: Required for both oral options. Having hepatitis B doesn’t disqualify you, but your provider needs to know about it
- STI screening: Tests for chlamydia, gonorrhea, and syphilis are recommended for all sexually active patients starting PrEP
- Cholesterol and triglycerides: Only needed if you’re starting Descovy specifically
In many cases, your provider can order labs and write the prescription at the same visit, so you can start PrEP as soon as results come back. Some clinics draw blood the same day; others may send you to a separate lab.
Where to Get a Prescription
You don’t need to visit an HIV specialist or sexual health clinic, though both are great options. Any primary care doctor, urgent care provider, or nurse practitioner can prescribe PrEP. Community health centers and Planned Parenthood locations also prescribe it routinely.
Telehealth has made access even easier. Services like Mistr, PlushCare, Nurx, and Q Care Plus offer PrEP prescriptions through virtual consultations. You’ll still need to complete the required lab work, which usually means visiting a local lab for a blood draw, but the consultation and prescription happen online. This can be especially convenient if you live in a rural area or prefer not to discuss PrEP with your regular doctor.
How to Pay for PrEP
Under the Affordable Care Act, most private insurance plans are required to cover PrEP and its associated lab work with zero cost-sharing when you use an in-network provider. That means no copay, no coinsurance, and no deductible for the medication or the screening tests. This applies to most group and individual health plans.
If you don’t have insurance, several programs can help:
- Ready, Set, PrEP: A federal program that provides all PrEP medications at no cost to people who qualify
- Gilead Advancing Access: The manufacturer assistance program for Truvada and Descovy, available to uninsured patients (1-800-226-2056)
- Johnson & Johnson Patient Assistance Foundation: Covers Apretude for patients with no public or private insurance (1-800-652-6227)
- Harbor Path: A nonprofit that provides medications for uninsured individuals, including those on state waiting lists
Medicaid covers PrEP in many states as well. If you’re unsure which programs you qualify for, the PhRMA Medicine Assistance Tool is a single searchable database that links to most patient assistance programs and can point you toward options based on your coverage situation.
Ongoing Visits After You Start
PrEP isn’t a one-and-done prescription. You’ll need regular follow-up visits, typically every three months for oral PrEP or at each injection appointment for Apretude. At these visits, your provider will repeat your HIV test (this is non-negotiable, since taking PrEP while HIV-positive is harmful), check kidney function if you’re on a pill form, and screen for STIs.
These check-ins are also a chance to discuss whether PrEP is still the right fit, switch between formulations if side effects bother you, or stop PrEP if your circumstances change. You can restart PrEP at any time by going through the baseline testing process again.
Side Effects to Expect
Most people tolerate PrEP well. The most common complaints when starting oral PrEP are nausea, headache, and fatigue, sometimes called “start-up syndrome.” These symptoms typically fade within the first few weeks as your body adjusts. For the injectable version, soreness at the injection site is the most frequently reported issue.
Long-term, Truvada can slightly affect kidney function and bone density in some people, which is why kidney monitoring is part of your regular follow-up visits. Descovy was designed to reduce these effects and appears to be gentler on the kidneys and bones. Both oral formulations require hepatitis B monitoring because stopping the medication abruptly can cause a flare in people with underlying hepatitis B infection. Serious side effects are rare, and any kidney changes typically reverse after stopping the medication.
How Well PrEP Works
When taken consistently, oral PrEP reduces the risk of getting HIV from sex by about 99%. For people who inject drugs, consistent use reduces risk by at least 74%. The key word is “consistently.” Missing doses significantly reduces protection, particularly for vaginal sex exposure, where the medication takes longer to reach protective levels in tissue. The injectable form removes the adherence challenge entirely, since you only need to show up for an injection every two months after the initial doses.
PrEP reaches maximum protection at different speeds depending on the type of exposure. For receptive anal sex, daily oral PrEP reaches high protection after about seven days. For vaginal sex or injection drug use, it takes about 21 days of daily use. If you need protection sooner, the on-demand dosing method for Truvada (for receptive anal sex only) can provide coverage starting 2 to 24 hours before a sexual encounter.