If you were exposed in the last 72 hours — act now
Call these first:
NYC PEP Hotline: 844-373-7692 (24/7, connects you to same-day PEP anywhere in NYC)
NYS PEP Hotline: 844-737-4669 (business hours, New York State)
DC PEP Hotline: 202-299-3737 (24/7, Washington DC)
Nearest ER or urgent care: They can prescribe PEP and start you same-day
Call your doctor: Any physician or NP can prescribe PEP
CDC PEPline (for your doctor): 1-888-448-4911 (clinician expert consultation)
What is PEP?
PEP stands for post-exposure prophylaxis — a 28-day course of HIV medications taken after a potential HIV exposure to prevent infection. When started within 72 hours of exposure and taken consistently for the full 28 days, PEP is highly effective at preventing HIV.
PEP is different from PrEP. PrEP (pre-exposure prophylaxis) is taken before potential exposure as ongoing protection. PEP is taken after a specific exposure as an emergency intervention.
The current CDC-recommended PEP regimen is tenofovir/emtricitabine (Truvada or generic TDF/FTC) plus either dolutegravir (Tivicay) or raltegravir (Isentress). You take it for 28 days, with routine HIV and lab testing throughout.
The 72-hour window
PEP effectiveness is time-dependent. The sooner you start after exposure, the better it works.
- Within 2 hours: Highest effectiveness
- Within 24 hours: Very effective
- Within 72 hours (3 days): Still effective, but effectiveness decreases over time
- After 72 hours: PEP is generally not recommended — the virus has likely established infection
If you've been exposed and it's been less than 72 hours, don't wait to "see how you feel" or research extensively. Call an ER, a PEP hotline, or a telehealth service now.
Situations when PEP is typically recommended
PEP is considered for people who've had a potential HIV exposure in the last 72 hours, including:
- Condom break or no condom used during sex with someone HIV-positive or of unknown HIV status
- Sexual assault or rape
- Sharing needles or syringes
- Occupational exposure (needlestick injury for healthcare workers)
- Exposure to blood or body fluids from a known HIV-positive person
A clinician will evaluate your specific exposure. Not every potential exposure warrants PEP, but when in doubt within the 72-hour window, the conservative approach is to start PEP and reassess.
Where to get PEP immediately
1. Emergency Room (fastest for most people)
Any ER in the U.S. can evaluate you for PEP and provide an initial supply (typically 3–7 days worth). ERs can start you on PEP within an hour, no appointment needed. Important to know: many ERs will give you enough medication to bridge to a follow-up provider who handles the rest of the 28-day course. Bring identification if you have it, but ERs serve everyone regardless of ID, insurance, or immigration status.
2. Dedicated PEP Hotlines (where available)
Some cities have 24/7 PEP hotlines staffed by people who coordinate same-day PEP access:
- NYC: 844-373-7692 (24/7)
- NY State: 844-737-4669 (business hours)
- DC: 202-299-3737 (24/7; getpepdc.com)
- Philadelphia: 833-933-2815 (24/7)
- South Florida: Care Resource 754-444-6740
3. Urgent care or your regular doctor
Any physician or nurse practitioner can prescribe PEP. If your doctor is reachable, call and ask about same-day PEP. Urgent care clinics can also prescribe PEP, often for less money than an ER visit.
4. Online telehealth (same-day, often free)
Services like MISTR provide same-day PEP online. You complete a brief intake, a licensed provider reviews it immediately, and medication can be filled at a local pharmacy or shipped overnight. For people within the 72-hour window who don't want to go to an ER, this is often the fastest path — especially late at night or on weekends.
Need PEP urgently? MISTR handles same-day online
If you're within the 72-hour window and don't want to go to an ER, MISTR's providers review urgent PEP requests quickly. Medication can be filled at a local pharmacy the same day.
Get started with MISTR →ANDR735
How much does PEP cost without insurance?
PEP's retail cost without insurance or assistance is significant: $600 to $4,000+ for a full 28-day course. The cost breakdown typically looks like this:
| Cost component | Typical cash cost |
|---|---|
| TDF/FTC (28 days, generic) | $17–$60 with GoodRx |
| Dolutegravir (28 days, Tivicay) | ~$2,800 |
| OR Raltegravir (28 days, Isentress) | ~$2,000 |
| OR Biktarvy (28 days, all-in-one) | ~$3,800 |
| ER visit (if used) | $500–$3,000 |
| Lab work | $200–$900 |
| Total without assistance | $600–$4,000+ |
The TDF/FTC portion is genuinely cheap now that generics exist. The cost driver is the third drug in the PEP regimen (dolutegravir, raltegravir, or similar) which is brand-only. Add the ER visit and labs and the total adds up fast. But multiple programs can reduce the total cost to $0.
How to get PEP for free
Gilead Advancing Access (urgent PEP pathway)
Gilead's urgent PEP assistance program is one of the best-designed emergency pharmaceutical programs in existence. For uninsured patients with income ≤500% of the Federal Poverty Level (~$75,300/year for an individual), the process works like this:
- Your provider faxes a letter of medical necessity to Gilead
- Your provider calls Gilead at 1-800-226-2056
- Gilead processes urgent PEP requests in 5–10 minutes
- A voucher number is issued
- You fill the prescription at a retail pharmacy at no cost
This covers Biktarvy and Descovy portions of PEP for uninsured patients. Note: Gilead ended brand Truvada assistance in January 2025, but PEP regimens now commonly use Biktarvy (which Gilead still covers) or the cheap generic TDF/FTC.
ViiV Healthcare (for dolutegravir)
ViiV's Patient Assistance Program provides free dolutegravir (Tivicay, commonly used in PEP) for uninsured patients below 500% FPL. Call 1-844-588-3288. Same-day phone enrollment is possible — income is verified verbally and a retail pharmacy voucher is issued immediately.
Merck (for raltegravir)
Merck's Patient Assistance Program provides free raltegravir (Isentress, another PEP third-drug option) for uninsured patients below 400% FPL. Call 1-800-727-5400 or visit merckhelps.com/ISENTRESS. Applications received before 5 PM EST ship overnight.
Telehealth services
Services like MISTR can coordinate PEP at $0 for many patients through a combination of 340B pricing, manufacturer assistance, and insurance billing. This avoids the ER visit cost entirely and can be significantly faster for people within the 72-hour window.
Hospital financial assistance
Most hospitals have financial assistance programs that can reduce or eliminate ER visit costs for people below certain income thresholds. Even after the fact, you can apply for financial assistance and potentially have the bill reduced or forgiven.
After PEP ends, PrEP is usually the next step
If you needed PEP once and you're at ongoing risk, PrEP provides continuous protection without another emergency. MISTR can transition you directly from PEP to PrEP with no gap in coverage.
Get started with MISTR →ANDR735
Starting PEP with telehealth: what the process looks like
Step 1: Initial intake (under 10 minutes)
You describe the exposure and timing. A licensed provider reviews whether PEP is appropriate. For time-sensitive PEP requests, most telehealth platforms flag them as urgent and handle them within hours.
Step 2: Provider prescription
If PEP is appropriate, the provider writes a prescription. The prescription can typically be filled at a local pharmacy (CVS, Walgreens, Walmart) that same day, or the medication is shipped overnight.
Step 3: Baseline labs
You'll also need baseline labs — HIV test, hepatitis B/C, kidney function — which can be done at home with a self-collection kit or at a local lab (Quest, LabCorp). Labs happen in parallel with starting PEP, not as a prerequisite.
Step 4: 28-day course with check-ins
You take PEP for 28 days. The telehealth platform coordinates follow-up labs and any questions along the way.
Step 5: Post-PEP testing and (often) PrEP transition
After PEP, you'll be tested for HIV at specific intervals (typically 4–6 weeks and 3 months post-exposure) to confirm you remain negative. For most people who take PEP, this is also the right time to start PrEP for ongoing protection. Your provider will walk you through the transition.
What to do DURING your 28 days on PEP
- Take every dose on time. Missing doses significantly reduces PEP effectiveness. Set phone alarms. Use a pill box.
- Use condoms / protection during PEP. You're not yet protected; PEP protects against this specific exposure, not future ones.
- Tell your provider about any side effects. Common PEP side effects include nausea, fatigue, headache. Often manageable but always worth reporting.
- Don't skip follow-up testing. HIV testing at 4–6 weeks and 3 months is part of the PEP protocol.
- Plan your PrEP transition. If you had this exposure once, you may be at ongoing risk. PrEP for ongoing protection is almost always the right next step.
After PEP: transitioning to PrEP
If your final HIV test after PEP is negative and you remain at risk for future exposures, starting PrEP is almost always the right move. PEP is an emergency intervention; PrEP is ongoing protection. The transition can happen smoothly right at the end of your PEP course — many clinicians bridge directly from the last PEP dose to PrEP.
For a full guide to getting PrEP, see our free PrEP online guide or how to get free PrEP.
Frequently asked questions
How long after exposure can I start PEP?
PEP must be started within 72 hours (3 days) of exposure. The sooner the better — within the first few hours is ideal. After 72 hours, PEP is generally not recommended because the virus has likely established infection.
How much does PEP cost without insurance?
Retail cost without assistance is typically $600–$4,000+ for a full 28-day course, including medications, ER visit (if used), and labs. However, multiple pathways reduce this to $0: Gilead's urgent PEP program for uninsured patients under 500% FPL (processed in 5–10 minutes), ViiV's dolutegravir assistance, Merck's raltegravir assistance, and telehealth services coordinating the full package at no cost.
Can I get PEP online?
Yes. Telehealth services like MISTR provide same-day PEP online. After a brief intake, a licensed provider reviews the exposure and prescribes PEP. Medication can be filled at a local pharmacy or shipped overnight. For time-sensitive requests, telehealth is often faster than an ER visit.
Does insurance cover PEP?
Yes — commercial insurance, Medicaid, and Medicare all typically cover PEP. Under ACA rules, PEP is generally covered without cost-sharing as a preventive service. Emergency-room-administered PEP may have ER visit copays depending on your plan.
Can I get PEP if I'm undocumented?
Yes. Emergency rooms serve everyone regardless of ID or immigration status. Federally Qualified Health Centers (FQHCs) provide PEP without documentation requirements. Gilead's Advancing Access program serves undocumented patients and doesn't require a Social Security Number. Getting PEP will not affect your immigration status.
What are the side effects of PEP?
Modern PEP regimens are better tolerated than older protocols, but side effects still occur. Most common: nausea, fatigue, headache, and diarrhea, typically in the first 1–2 weeks. Side effects usually resolve as your body adjusts. Report severe or persistent side effects to your provider — sometimes the regimen can be adjusted.
Can I have sex while on PEP?
Yes, but use protection (condoms). PEP protects against the specific past exposure, not against future exposures during the 28-day course. If you're at ongoing risk, plan to transition to PrEP after PEP ends.
What's the difference between PEP and PrEP?
PrEP (pre-exposure prophylaxis) is taken before potential exposure as ongoing HIV prevention — a daily pill or injection you take continuously. PEP (post-exposure prophylaxis) is taken after a specific exposure as an emergency intervention — a 28-day course that must start within 72 hours. If you had a single exposure and you're not at ongoing risk, PEP alone may suffice. If you have ongoing risk of exposure, PrEP is more practical and effective than repeated courses of PEP.
What if I was sexually assaulted?
ERs in all 50 states provide free PEP and related services (including forensic exam, pregnancy prevention, and STI prophylaxis) for survivors of sexual assault. The federal Violence Against Women Act provides funding so that these services are free regardless of insurance. You are not required to file a police report to receive PEP or medical care. The National Sexual Assault Hotline (1-800-656-4673) can connect you with local resources.
Get PEP online today — same-day prescription, $0 for most
MISTR offers same-day PEP prescriptions online. Brief intake, urgent provider review, prescription filled at a local pharmacy. Works for insured and uninsured patients. If you're within the 72-hour window, start now.
Start free consultation →ANDR735
Using this code helps keep FreePrEP.org running at no cost to you. MISTR's $0 PrEP is funded through insurance reimbursement and 340B program partnerships — you pay nothing whether you have insurance or not.