The Supreme Court's June 2025 ruling in Kennedy v. Braidwood Management confirmed that private insurance must cover PrEP at $0 — no copay, no deductible, no coinsurance. This includes medication, labs, and clinic visits. If your insurer is charging you anything, they're non-compliant with federal law.
Let's make this simple: if you have private health insurance in the United States, PrEP is legally free. Not discounted. Not "covered with a copay." Free. Zero dollars out of pocket.
This isn't a suggestion. It's federal law, upheld by the Supreme Court.
The Legal Foundation
The Affordable Care Act (ACA) requires private health insurance plans to cover preventive services rated "A" or "B" by the U.S. Preventive Services Task Force (USPSTF) with zero cost-sharing. PrEP received an "A" rating — the highest possible — meaning insurers must cover it completely.
This was challenged. In 2022, a federal judge in Texas ruled in Braidwood Management v. Becerra that the USPSTF's structure violated the Appointments Clause of the Constitution, potentially invalidating the preventive services mandate entirely. If upheld, this would have allowed insurers to start charging for PrEP, cancer screenings, vaccinations, and dozens of other preventive services.
It wasn't upheld. In June 2025, the Supreme Court ruled 6-3 in Kennedy v. Braidwood Management (606 U.S. 748) that the USPSTF's structure is constitutional. The ACA's preventive services mandate stands. PrEP remains $0.
What's Covered at $0
The mandate covers more than just the pills:
- All FDA-approved PrEP medications — Truvada, Descovy, generic tenofovir/emtricitabine, Apretude (injectable), and Yeztugo (twice-yearly injectable)
- Required lab work — HIV testing, kidney function tests, STI screening, hepatitis B testing
- Clinical visits — provider consultations for PrEP initiation and ongoing monitoring
All of this must be $0 — no copay, no deductible, no coinsurance, no prior authorization (in states that have banned it for PrEP, including New York as of December 2024).
Not sure if your insurance covers PrEP correctly?
MISTR handles insurance billing directly and knows exactly what your plan must cover. If there's a problem, they'll deal with it — you just get your medication.
Start Free PrEP with MISTR →Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.
What to Do If Your Insurer Is Charging You
If you're being charged anything for PrEP or its associated lab work, your insurer is out of compliance. Here's how to fix it:
- Call your insurer and reference the ACA preventive services mandate, Section 2713. Specifically cite the USPSTF "A" rating for PrEP and the June 2025 Supreme Court ruling in Kennedy v. Braidwood Management.
- Request a formal coverage determination in writing. This creates a paper trail.
- File a complaint with your state insurance commissioner. Every state has one, and they have enforcement authority.
- Contact the Patient Advocate Foundation at 1-866-512-3861. They specialize in insurance navigation and can advocate on your behalf.
In the meantime, don't go without PrEP while fighting the bureaucracy. Gilead's Co-Pay Coupon can cover up to $7,200/year in copays while you resolve the issue. And telehealth platforms like MISTR will handle the insurance billing and advocacy for you.
Let someone else deal with insurance.
MISTR bills your insurance directly and ensures you pay $0 for PrEP as the law requires. No paperwork, no phone fights.
Start Free PrEP with MISTR →Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.
The One Remaining Legal Uncertainty
While the Supreme Court preserved the ACA mandate, it remanded (sent back to the lower court) a separate claim based on the Religious Freedom Restoration Act (RFRA). The plaintiffs argued that being required to cover PrEP violates their religious beliefs. That claim remains unresolved.
However, even if the RFRA claim ultimately succeeds for some employer-sponsored plans, it would create a narrow exemption — not a broad rollback. The vast majority of insured Americans would remain covered.
Bottom Line
The law is clear. PrEP is free for insured Americans. If someone tells you otherwise — including your insurance company — they're wrong, and you have legal recourse. Don't let a billing error or corporate foot-dragging keep you from a medication that prevents HIV.
Get started with $0 PrEP today.
MISTR provides free PrEP in all 50 states. Insured or uninsured, you pay nothing. They handle all the billing.
Start Free PrEP with MISTR →Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.
Frequently Asked Questions
Does my insurance really have to cover PrEP at $0?
Yes. The ACA requires all private insurance plans to cover USPSTF 'A'-rated services at zero cost-sharing. PrEP has an 'A' rating. The Supreme Court confirmed this mandate in June 2025.
What if my employer's plan doesn't cover PrEP?
If it's a private insurance plan regulated under the ACA, it must cover PrEP at $0. Self-insured employer plans (ERISA plans) are also subject to the mandate. If your plan charges for PrEP, file a complaint with your state insurance commissioner.
Does the $0 coverage include lab work and doctor visits?
Yes. The mandate covers the medication, required laboratory testing, and clinical visits associated with PrEP. All must be $0 out of pocket.