PrEP - How do I get it?
Go to a doctor you’re comfortable with. Any doctor can prescribe PrEP. If you have a family doctor that you feel comfortable with, that is a good place to start. There is ongoing testing and medical care required with PrEP, so accessing PrEP through a doctor that you already have a connection with is ideal. If you don’t have a family doctor, or you aren’t comfortable talking about PrEP with your doctor, you can get a referral to an HIV clinics or HIV specialists who are providing prevention services. If you have insurance coverage through the Ontario Drug Benefit (ODB), through the Trillium Drug Program, ODSP or Ontario Works, you will need to get your prescription from an HIV specialist. Ask your doctor, or a doctor at a walk-in or sexual health clinic for a referral to an HIV clinic that provides HIV prevention services, such as the HIV Prevention Clinic which is run weekly by the Immunodeficiency Clinic of the Toronto General Hospital.
Be specific about your sexual activity. It’s important for you to be clear and honest with your doctor about the types of sex that you’re having, or want to be having, why you’re interested in taking PrEP, and how easily you think will be able to take the medication consistently on a daily basis. This way your doctor can make an accurate assessment of your risk of acquiring HIV, and help you decide whether PrEP is right for you. Your doctor may then also be able to provide information about relevant sexually transmitted infections (STIs) – including making sure you are getting the right STI prevention and testing options. Finally, your doctor will be able to tell you how to safely get off PrEP based on your last possible exposure that posed a risk for HIV.
Be ready to get tested for HIV & STIs. Before starting PrEP, you will have to be tested for HIV. This is because if someone who is already HIV-positive beings taking PrEP, they may develop a resistance to Truvada (the medication used as PrEP). Truvada is also used as a treatment medication for people living with HIV, so developing a resistance to this medication would mean that the person could not use Truvada for treatment. Testing for HIV is required every 3 months while taking PrEP, so that HIV can be detected as early as possible if someone does become HIV positive (to help prevent drug resistance). Regular STI testing is also part of the PrEP regimen, as having an STI can increase the chances of getting HIV. Doctors will also want to know if you have any pre –existing conditions such as Hep B before administering PrEP.
Be prepared to educate your doctor. Because PrEP is a fairly new option, your doctor may not be familiar with it. Putting some time into researching PrEP ahead of your appointment can equip you with knowledge that you can share with your doctor. We don’t have Canadian clinical guidelines for PrEP yet, so any documentation that you are able to bring with you may help, such as BC’s PrEP Guidelines, the CDC PrEP Factsheet, the World Health Organization’s Endorsement of PrEP, and the US PrEP Guidelines. Being prepared may also give your doctor confidence that you understand PrEP. Your doctor may still need some time to research the medication before prescribing it.
Ask about coverage options. Truvada is an expensive medication, and many of us are not able to afford it without financial help. Talk with your doctor and/or your pharmacist to see if they have any suggestions. See our Costs & Coverage section for more information about getting Truvada covered.
Truvada costs around $1000 per month. That’s too expensive for many of us. Fortunately, there may be coverage options available to you.
If you have a private insurance policy: whether you pay for the insurance yourself or you get it through your employer, your policy may cover Truvada. If it doesn’t currently cover Truvada, you may be able to purchase an upgrade for your coverage, even if it’s a workplace insurance plan. Pharmacists are knowledgeable about navigating insurance plans, and it may be a good idea to have them call your insurance company for you. If you call your insurer directly, try to keep the conversation brief, and only use the policy number and the Drug Identification Number (DIN) for Truvada (Truvada's DIN is 02274906).
Note: Some drug policies have a limit on how much they will pay towards prescriptions each year, or over a lifetime. Because Truvada is so expensive, you may hit that limit sooner than expected. Make sure you know what your prescription benefits limit is. Often it is in section of your policy called “extended health care benefits.”
In Ontario, we have a provincial drug program called the Ontario Drug Benefit (ODB) that is available to people on Ontario Works, the Ontario Disability Support Program (ODSP) and the Trillium Drug Program. The ODB currently includes Truvada on the list of drugs that they pay for, but it is listed only for use as treatment, not prevention. If you are member of ODSP, Ontario Works or the Trillium Drug program talk to your pharmacist about your options.
Currently, the federal and provincial governments are going through a process to decide whether to cover Truvada as PrEP on provincial drug programs. PrEP advocates across the province are pushing to have Truvada covered with as few limitations as possible. To find out more, and to sign your name to support this push, check out PrEPOntario.org.
Many indigenous Canadians can have PrEP covered through the Non-Insured Health Benefits (NIHB) program. A prescription for PrEP is still needed, but once that is acquired the drug will be covered by the Federal Government. Specifically, eligibility for coverage for indigenous Canadians is extended to:
• A registered Indian according to the Indian Act;
• An Inuk recognized by one of the Inuit Land Claim organizations
*Please note that if you qualify under one of the above groups, and you are entitled to receive benefits from another healthcare plan (i.e. public or private), you must submit your claims to these plans prior to submitting them to the NIHB program. If you are not successful in securing coverage through those plans, then you may access coverage through NIHB. More details about this here: http://www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/benefit-prestation/index-eng.php#a1
Your pharmacist is a great resource to discuss coverage options with. If you don’t have a pharmacist that you regularly see, try to find one that is knowledgeable about HIV medications.