PrEP list prices vs. what you actually pay
PrEP list prices look terrifying. But almost nobody pays list price. Between insurance mandates, manufacturer programs, and telehealth 340B models, most Americans can get PrEP at $0.
| Medication | List price/month | With insurance (ACA) | Without insurance |
|---|---|---|---|
| Generic TDF/FTC (generic Truvada) | $30–$60 | $0 | $30–$60 (GoodRx) or $0 via 340B telehealth |
| Descovy (TAF/FTC) | ~$2,200 | $0 | $0 via Gilead MAP (under 500% FPL) |
| Apretude (cabotegravir injection) | ~$4,038/injection (every 2 mo) | $0 with savings card | $0 via ViiVConnect PAP |
| Yeztugo (lenacapavir injection) | ~$14,109/injection (every 6 mo) | $0 with copay program | $0 via Gilead MAP |
The bottom line
If you have private insurance: $0 (ACA preventive mandate). If you're uninsured with income under 500% FPL: $0 (manufacturer PAPs + telehealth). If you're on Medicaid: $0–$3. The only people who reliably face costs are Medicare patients without copay fund assistance and high-income uninsured patients who don't qualify for PAPs.
What you pay by insurance type
Private / employer insurance
The ACA requires $0 cost-sharing for PrEP under the USPSTF Grade A recommendation. This covers medication, labs, and clinical visits. If you face a copay, the Gilead copay savings card covers up to $7,200/year for Descovy or Yeztugo. Full guide →
Uninsured
Gilead MAP provides free Descovy/Yeztugo (under 500% FPL, no SSN needed). ViiVConnect provides free Apretude. Telehealth platforms like MISTR cover labs and visits at $0 through 340B partnerships. Generic TDF/FTC has no free program — cost is ~$30–$60/month via GoodRx. Full guide →
Medicaid
All state Medicaid programs cover PrEP. Most copays are $0–$3. Injectable options may require prior authorization. Full guide →
Medicare
Covered under Part D with variable copays. Manufacturer copay cards cannot be used. Good Days Foundation (up to $7,500/yr) and Medicare Extra Help (LIS) can reduce costs. Full guide →
Additional costs beyond medication
PrEP isn't just the pill or injection. You also need:
- Initial lab work: HIV test, kidney function, hepatitis B, STI screening — covered at $0 under ACA for insured; included with telehealth platforms; sliding-fee at FQHCs
- Clinical visit: Prescribing consultation — covered at $0 under ACA; included with telehealth; sliding-fee at FQHCs
- Quarterly follow-up: HIV test and labs every 3 months — same coverage as above
- Injection administration: For injectables, a provider visit for the shot — Gilead provides $100/visit assistance for Yeztugo; ViiV has ASOC network for Apretude
Skip the complexity — get everything at $0
MISTR handles medication, labs, consultations, and delivery — all at $0 for insured and uninsured patients in all 50 states. No need to juggle separate programs.
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Why does the list price matter if nobody pays it?
The $2,200/month Descovy list price matters because it's the basis for 340B economics. Covered entities buy at the discounted 340B price (~$500–$1,000) and bill insurance at or near list price. The spread ($900–$2,200 per prescription) funds free care for uninsured patients. Higher list prices actually enable more access in this system — which is counterintuitive but real.
This also explains why 340B-based telehealth platforms prescribe brand Descovy over cheaper generic TDF/FTC: the margin on Descovy funds the entire operation. Learn more about how $0 telehealth PrEP works →