Comprehensive Healthcare

Comprehensive Healthcare

PrEP (pre-exposure prophylaxis) is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective for preventing HIV.

This section answers some of the most common questions about PrEP.

Some people think PrEP is expensive and out of reach. But that’s not the case. Most people in Ontario already have a private or public drug plan that will cover all or most of the cost of PrEP. There are also ways for people who don’t have a drug plan to pay for PrEP. Scroll down to learn more about accessing PrEP with different drug plans.

Are you ready to start PrEP but not sure how to pay for it? PrEPStart provides three months of PrEP free for people who do not have a drug plan. It allows you to start PrEP right away and gives you three months to find the drug plan that’s right for you.

 

Different ways to pay for PrEP

Private drug coverage

You may already have coverage for PrEP through work benefits, a family member’s coverage or private insurance you pay for yourself.

If you already have private drug coverage through your work or a family member or because you pay for it yourself, your plan likely covers at least some of the cost of PrEP. The amount you pay for a prescription and the amount your insurance company pays depends on your plan.

If you want to know whether your plan covers PrEP and how much it will cost you to fill your prescription, talk to a pharmacist. The pharmacist will need to see the card from your insurance provider and will also need the drug identification number to see if your plan covers that medication.

Here are various brands of PrEP with their corresponding drug identification number:

  • Teva-Emtricitabine/Tenofovir: 02399059
  • APO-Emtricitabine/Tenofovir: 02452006
  • Mylan-Emtricitabine/Tenofovir: 02443902
  • Truvada (name-brand): 02274906
  • Descovy (tenofovir alafenamide/emtricitabine) DIN: 02454424

If the amount that you have to pay is still high, you may be able to use the Trillium Drug Plan to help with those costs. See “See Trillium Drug Program.”

One option for people who currently do not have drug coverage is to buy a private plan (e.g. Blue Cross, Green Shield) before starting PrEP. If you do not have any pre-existing health conditions, a private plan can be a cheap way to get PrEP. Your provider may be able to refer you to someone who can help you figure out the best drug coverage for you .

 

People with no or limited drug coverage

The Trillium Drug Program helps people with high medication costs pay for PrEP.

If you don’t have a drug plan or your plan doesn’t cover the full cost of your PrEP, you may be eligible for the Trillium Drug Program:

  • If your household’s total annual drug costs are more than 3-4% of your total household income, you can apply to the Trillium Drug Program. Your household income is based on the amount of income you earn plus the income of a partner or any other family member who you support or who supports you financially.

 

Visitors to Canada without drug coverage

Visitors to Canada can import prescription medications for ongoing treatment directly to their home address in Canada. Online pharmacies are able to get PrEP medications from countries outside Canada for as little as $30 a month. When you are importing medications to Canada, you have to give documents to Canadian Border Services that prove you are a visitor to Canada. Follow this link for more detailed information about how to import medication.

 

Provincial Drug Programs

The Ontario Drug Benefit covers the cost of PrEP for Ontarians enrolled in Ontario Works, the Ontario Disability Support Program, home care or community care programs.

If you are enrolled in Ontario Works, the Ontario Disability Support Program, home care or community care, then you have coverage for a variety of medications, including PrEP, through the Ontario Drug Benefit program.

  • When you fill a prescription, show your OHIP card to the pharmacist and you will only have to pay up to $2 each time you fill a prescription.

 

OHIP+

If you are 24 years old or younger, have a valid OHIP health card, and do not have private drug coverage, you are automatically covered by OHIP+. Show your OHIP card to the pharmacist and you will only have to pay up to $2 each time you fill your prescription.

As of April 1, 2019, OHIP+ will not cover the cost of PrEP for Ontarians 24 years old and younger who already have private drug coverage. Learn more about OHIP+ here.

 

Ontarians age 65 and older who have a valid OHIP card are covered for PrEP.

If you are 65 years old or over and have a valid OHIP card, you are covered by Seniors Coverage.

This program provides different levels of coverage based on your household income:

  • If you are single and earn $19,300 or less after taxes or you are part of a couple with a combined yearly income of $32,300 or less after taxes, you will pay up to $2 each time your fill your prescription.
  • If you are single and earn more than $19,300 after taxes or you are part of a couple with a combined yearly income of more than $32,300 after taxes, you will pay the first $100 of all your prescription costs per person each year and then up to $6.11 for each prescription filled or refilled.

 

Federal Programs

People using the Interim Federal Health Program in Ontario are covered for PrEP.

If you are enrolled in the Interim Federal Health Program (IFHP) you have coverage for a variety of medications, including PrEP. IFHP only covers your medication costs if you do not have coverage through another government drug program or through private insurance.

  • When you are filling a prescription, show your IFHP coverage document to your pharmacist.

 

People eligible for the Non-Insured Health Benefits program are covered for PrEP.

The Non-Insured Health Benefits program is only open to some Indigenous people with specific legal status in Canada, including First Nations people registered as an Indian under the Indian Act or Inuks who are recognized by an Inuit Land Claim organization. Note: NIHB only covers your medication costs if you do not have drug coverage through another government program or through private insurance.

  • If you think you might be eligible or want more information to see if you can apply, contact the Ontario regional NIHB office at 1-800-640-0642.

 

Canadian Armed Forces personnel are covered for PrEP through Canadian Forces Health Care.

If you are a member of the Armed Forces, you can access PrEP through the health coverage you have as part of serving. If health care providers at your base, wing or unit are not willing to prescribe PrEP, you can use your Canadian Forces Health Care Identification card (sometimes called a Blue Cross Card) at off-base clinics to access PrEP and at community pharmacies to pay for PrEP and other prescriptions.

  • If you do not have a Canadian Forces Health Care Identification card, call 1-866-886-1304 to ask about acquiring one. You do not have to say you plan to use your card to access PrEP.

 

Veterans Affairs Canada (VAC) health benefits will cover the cost of PrEP for veterans who are enrolled in VAC health programs, such as Long-Term Care, Disability Benefits, the Veterans Independence Program or the War Veterans Allowance with Veterans Affairs Canada.

When you visit a pharmacy to get your medication, bring your VAC card. The pharmacist will bill the cost of your medication and any dispensing fees directly to VAC.

 

What is PrEP?

PrEP, or Pre-Exposure Prophylaxis, is a highly effective way for people at high risk to have more control over their sex lives and protect themselves from HIV.

PrEP involves taking one pill a day. The medication prevents the human immunodeficiency virus (HIV) from multiplying which means that, if you are exposed to HIV, PrEP makes it very difficult for the virus to infect your body.

When taken daily, PrEP can significantly reduce the risk of acquiring HIV.

PrEP works to prevent HIV but it doesn’t protect you against other sexually transmitted infections (STIs) or prevent pregnancy. Therefore, people using PrEP should also take other steps to protect their sexual health, including regular STI testing.

 

How do we know PrEP works?

Clinical trials have shown that PrEP works when it’s taken correctly and consistently.

The small number of people who have become infected with HIV while using PrEP were not taking it every day.

PrEP only works if you have enough of the medication in your body, so you need to take PrEP every day.

 

How long do I have to take PrEP for it to start protecting me?

The number of days you have to take PrEP to establish the right levels of drug in your body varies. For people having anal sex, we recommend 7 days. For people having vaginal or front hole sex and for people who inject drugs, we recommend 21 days.

 

Is PrEP safe? What are the side effects?

PrEP is safe. The drugs used for PrEP have been part of safe, effective HIV treatments since 2004.

Most people taking PrEP have no side effects. For those who do, the most common ones are nausea, upset stomach, fatigue and headaches. These symptoms often go away within a month of starting PrEP.

In rare cases, PrEP can cause kidney or bone problems. That’s why anyone taking PrEP should see their health care provider every three months to be monitored for any signs of these problems.

 

Is PrEP right for me?

PrEP is only one way to prevent HIV and improve your sexual health – and it’s not right for everyone.

PrEP may be right for you if you are:

  • A man who has condomless anal sex with other men and has any of the following risk factors:
    • rectal gonorrhoea or other sexually transmitted infections (STIs) of the rectum
    • infectious syphilis
    • has had more than one course of PEP (post-exposure prophylaxis)
    • an HIV-positive partner who does not have a suppressed viral load
    • a partner(s) whose HIV status is unknown
    • a high score on a valid HIV risk assessment tool
    • used methamphetamines such as crystal or speed in the past 6 months
    • injects drugs and sometimes share needles
  • A transgender woman who has condomless anal sex and any of the following risk factors:
    • rectal gonorrhoea or other sexually transmitted infections (STIs) of the rectum
    • infectious syphilis
    • has had more than one course of PEP (post-exposure prophylaxis)
    • an HIV-positive partner who does not have a suppressed viral load
    • a high score on a valid HIV risk assessment tool
    • used methamphetamines such as crystal or speed in the past 6 months
    • injects drugs and sometimes share needles
  • A heterosexual man or woman who:
    • has condomless anal or vaginal sex with an HIV-positive partner who does not have a suppressed viral load
    • has condomless anal or vaginal sex with a partner(s) whose HIV status is unknown
    • has condomless anal or vaginal sex with a partner who injects drugs
    • has had infectious syphilis
    • has had more than one course of PEP (post-exposure prophylaxis)
    • injects drugs and sometimes share needles

Use the private, assessment tool on this website to see if PrEP might be right for you.

Interested in PrEP?

Answer a few questions to find out if PrEP would be a good way to improve your sexual health. Then talk to a health care provider so you have all the information you need to decide whether PrEP or another form of HIV prevention is right for you.

 

FAQs

Does PrEP work for women?

Yes, PrEP can be an effective form of HIV prevention for women.

Is PrEP safe to use with birth control?

PrEP is not a birth control option – it doesn’t prevent pregnancy. However, it is safe to use with all forms of birth control including oral contraceptives, IUDs and condoms.

Is PrEP safe if I am pregnant or trying to have a baby?

Yes, PrEP is safe for pregnant women or women trying to conceive. There isn’t a lot of research on using PrEP during pregnancy and breast feeding/chest feeding but there is a lot of research that shows it’s safe for pregnant women to use the same drugs for HIV treatment. If you have questions about using PrEP during pregnancy or while breast feeding/chest feeding, talk to your doctor.

Does PrEP work for trans folks?

Yes, PrEP can be an effective way for trans and gender diverse people to take some of the worry out of sex and prevent HIV. PrEP is safe to take with different types of hormone therapy.

Research on using PrEP after gender affirming surgery is limited. Most guidelines suggest that trans people who have had gender affirming surgeries should wait 21 days for PrEP to be effective for front hole sex.

Does PrEP work if I use recreational/street drugs?

PrEP is safe to take if you are using recreational or street drugs, and it can be a good way to prevent HIV if you sometimes share needles.

If I take PrEP, do I still have to use condoms?

PrEP will protect you from HIV but it will not protect you from other STIs or from getting pregnant. Using PrEP and condoms together is good for your sexual health.

 

What is PrEP?

PrEP is a once-a-day pill that prevents HIV infection by stopping the virus from spreading in your body. For people who do not have HIV, PrEP is another option for preventing HIV and maintaining your health. You can read more information about how PrEP works here.

 

What is PrEPStart?

The PrEPStart program provides three months of PrEP free for people who do not have a drug plan. It allows you to start PrEP right away and gives you three months to find the drug plan that’s right for you.

 

Why create PrEPStart?

Most people in Ontario already have a private or public drug plan that will cover all or most of the cost of PrEP. However, some people don’t have drug coverage and are not sure of the best way to pay for PrEP. PrEPStart was created to give those individuals access to PrEP while they figure out which private or public drug program is best for them.

Although Ontario does not cover the full cost of PrEP for everyone, there are many public drug plans that can give you access to PrEP at little or no cost.

PrEPStart gives you a free three-month starter pack of PrEP while you figure out which plan is best for you. It also provides information on the different ways to pay for PrEP and will connect you with someone who can help you apply for ongoing drug coverage.

 

SanoMed Medical Clinic in Downtown Toronto offers industry-leading PrEP consultation and medication. You may qualify for free PrEP consultation and medication, contact us to learn more.

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