Can I afford injectable PrEP? Can I get it at Strut?

Curious about injectable PrEP, but don’t know where to start or how you might afford it? We offer the two options for injectable PrEP, brand names Yeztugo and Apretude, at our clinic at Strut. Our clinic staff, SFAF pharmacy staff, and health navigators are experts in helping people access all forms of PrEP. 

Here, Brandon Ross, PharmD, AAHIVP, Pharmacist-in-Chage, and Alton Lou, Manager of Health Navigation, and Jorge Roman, RN, MSN, FNP-BC, AAHIVS, Director, NP & Research Services, explain some of the ins and outs of injectable PrEP access, and answer some commonly asked questions about how to afford these new medications. 

How can people access injectable PrEP at Strut?

Jorge: If you’re an existing client who is already on an oral form of PrEP, and you’re interested in Yeztugo or Apretude, you can talk to your clinician at your next PrEP follow-up appointment. Or, if that’s not happening for a while, please make a new appointment to discuss your PrEP options. We’d be happy to talk through the two options to explore which one may make the most sense for you.

If you are not already a client, and you’re interested in using injectable PrEP, make a PrEP enrollment appointment and we can discuss all PrEP options with you including Yeztugo and Apretude.

Brandon: If and when you’re prescribed Yeztugo or Apretude, next comes the fun part–figuring out if and how your benefits will cover these medications. More on that next. 

Will my benefits cover injectable PrEP?

Brandon: There isn’t a simple answer to this question. But first, I’ll share some good news. 

If you are uninsured, there are patient assistance programs that will provide injectable PrEP medications for free. (There are income restrictions with these programs.) We support our clients in getting enrolled in these programs, and we’ve had a lot of success in prescribing and administering both Yeztugo and Apretude to folks who are uninsured and meet income qualifications. 

It’s also really easy to access Yeztugo and Apretude if you’re on Medi-Cal, which is California’s Medicaid plan. There are no prior authorizations needed, and there are no co-pays for the injections. If you are on Medi-Cal, and are interested in injectable PrEP–come and talk to us. 

Access to injectable PrEP can be a little more difficult if you have a commercial insurance plan (e.g., Blue Cross Blue Shield, Health Net, etc.). 

First, it’s worth mentioning that insurance coverage is broken up into different parts… similar to how your dental coverage is different from your medical coverage. In the same way, your coverage for medications, or pharmacy coverage, is a different type of coverage than your medical coverage. Different insurances will dictate how injectable PrEP is covered–as a medical benefit or as a pharmacy benefit. 

When insurance companies cover injectable PrEP medications as a pharmacy benefit, in most cases, when it’s covered, it’s covered at no cost. And if it’s not covered at no-cost, folks might be able to use co-pay cards to help cover the expenses associated with it. (More info about co-pay cards later on.) So in these cases we’re able to fill the medication, it’s administered at our clinic, and clients meet with our health navigators to sign up for any payment assistance programs and co-pay cards as needed. 

Some other insurance companies cover injectable PrEP as a medical benefit. Right now, SFAF, cannot bill those insurance companies for the medication. (This may change in the future.) That means we’re not able to provide injectable PrEP to folks who fall in this category–who have commercial insurance with injectable PrEP covered as a medical benefit.  

How do I know if my insurance covers injectable PrEP as a medical benefit or pharmacy benefit? 

Alton: It might be difficult to determine on your own. If you’re interested, you can try checking your plan’s coverage information or contacting the insurance company directly. 

But, there’s no real need for our clients to do this type of sleuthing. If you have questions, come and talk to us. If you decide to pursue injectable PrEP as a client, we’ll do the heavy lifting for you. 

What does the process look like to actually receive injectable PrEP injections?

Jorge: First, clients get started with our PrEP program. At their appointment, they’ll discuss options with a clinician, and then they may start on an oral form of PrEP. 

If we find that the injectable option is what is preferred, we will coordinate with the Health Navigation and Pharmacy team to access the medicine. Once we get the medication, we’ll call the client to schedule their first injection. The client will come back to the clinic, get their labs drawn, have a short consult to review the clients medications and provide a quick review about the medication side effects and visit frequency, and then they receive their first injection.

What financial assistance is available to help pay for PrEP?

Alton: We oftentimes hear from clients that they hear injectable PrEP is “really expensive.” 

But each insurance plan is different! And if you meet income requirements for an assistance program, are on Medi-Cal, are uninsured, or for other reasons – you may pay $0 or close to $0 for injectable PrEP.

The manufacturers of Yeztugo and Apretude have copay cards that clients who have private insurance may qualify for. The co-pay cards are kind of like a pre-loaded debit card that can be used to pay for your out-of-pocked medication costs. And, some insurance companies actually count what is spent on the co-pay card as counted towards your deductible. We’ll help you sign up for these copay cards if you qualify for their assistance. 

Another resource that folks should know about is a California-based program called PrEP-AP. PrEP-AP can help you cover the cost of medications, copays, coinsurance, or other out-of-pocked costs associated with PrEP. It’s a really helpful program that we are able to sign up a lot of clients with. If you make up to $95,000/year, for a household of 1, you’ll qualify for PrEP-AP assistance. 

We’ll make a note that it can be difficult to anticipate what you’ll pay from one month to the next for these medications when going through private insurance. But, we are happy, and excited, to help you figure out and explore your options.