Editorial: If You’re Paying for PrEP, You Shouldn’t Be

When I went in for a routine PrEP follow-up after changing my insurance, I wasn’t expecting a bill. But at checkout, bam—a co-pay. It wasn’t much, but it threw me off. I’d always heard PrEP and its extras, classified as preventive care, were supposed to be free.

Standing there, I pulled out my phone and dug into it. Sure enough, the Affordable Care Act mandates that insurers cover preventive services rated “A” or “B” by the U.S. Preventive Services Task Force (USPSTF)—and PrEP’s got an “A.” That means no cost-sharing for the meds, visits, or lab work.

I showed the office my screen. The doctor shrugged, “I just code it how they tell me—it’s not preventive, it’s a follow-up.” Who “they” were, I was too flustered at the time to think to ask. But it sounded off. PrEP—pre-exposure prophylaxis—is all about prevention.

At home, I printed a PrEP coverage brief from NASTAD (National Alliance of State & Territorial AIDS Directors). It’s crystal clear: PrEP, as a preventive service, must be covered without co-pays, coinsurance, or deductibles. That includes quarterly visits, HIV and STI screenings, kidney tests, even counseling.

Next visit I brought the brief. No co-pay. PrEP was free—like it’s supposed to be.

This shouldn’t be some secret hack for people who sleuth through PDFs. But here we are.

If you’re paying for PrEP—or ditched it because of cost—this info could help you:

PrEP and its services should be free with private insurance or ACA Medicaid, including:

• HIV testing every three months
• STI screenings at all relevant sites
• Kidney function tests (creatinine, eGFR)
• Hepatitis B and C screening
• Pregnancy testing (if applicable)
• Behavioral and adherence counseling

If you’re charged, it’s likely a coding slip. The NASTAD brief says PrEP services must be billed as preventive—often with modifier 33—and you shouldn’t be responsible for cost-sharing. Many providers don’t know this or are willfully ignorant.

Fight back. Print the NASTAD brief (flashing it on your phone doesn’t seem to work, at least at my healthcare office). Ask your provider to code visits and labs as preventive. If your insurer balks, file a complaint with your state’s insurance department.

In a place like West Hollywood, where HIV prevention is priority one, these billing snafus are inexcusable. PrEP has already cut new infections nationwide. To keep that going, it’s got to be truly free—as the law demands.

So if you’re on PrEP, or considering it: Don’t let your insurance company or your doctor’s office skirt the law. If they try to charge you show the brief. It works. Spread the word—free PrEP is your right. Let’s make the system own up.