As one of the lucky people in the United States whose employer provides comprehensive health insurance, let me just preface this column by saying I know a lot of you guys out there aren’t as fortunate. I’m not ignoring you; the next column will be about how to access PrEP through publicly funded clinical trials and private programs that are popping up. But I wanted to start the access discussion with my experience getting a prescription for Truvada – the only drug currently FDA-approved for PrEP – and getting that prescription filled using my private health insurance.
When I stepped into my doctor’s office to discuss PrEP, I knew it wasn’t going to be a straightforward issue. Even most gay men I know are completely unaware that the FDA approved Truvada for PrEP, much less that it can reduce the risk of contracting HIV by upwards of 90% when taken daily (a recent study found it to be 99% effective among those that took the pill seven days a week). Having been judged plenty of times before by dumbass doctors who didn’t know what they were talking about when it came to gay men’s health, I didn’t go into my appointment with lofty expectations.
Given my experience, I came to my appointment prepared to talk about the clinical trials, their findings, and my sex life. I had rehearsed a speech about why I wanted Truvada, what PrEP was, and how the CDC suggested doctors should follow-up with patients on PrEP. I knew that I was far better informed about the drug, and that I was ultimately a much better judge of whether I was deserving of a prescription than any doctor. But I was nonetheless prepared to pretend like they had some kind of expertise that I needed to consult. But before I could get the words “pre-exposure prophylaxis for HIV” out of my mouth, my doctor was brusquely pushing me out the door with a referral to an infectious disease specialist. Clearly, she didn’t want to deal with me or my sex life.
Rebuffed, I had to wait another six weeks for my fancy appointment with the specialist. When they finally called my name to see the doctor, I began to prepare what I expected would be an interrogation regarding how many people had put what body parts in which of my holes. While the nurse took my vitals, I sat silently, cataloguing my recent flings. The adorable twink who came in his pants while we were making out (I tried not to laugh). The hung top who fucked me haphazardly with a magnum condom (it felt like a garbage bag). And that monster bottom who I turned into a top for one glorious night (so worth the effort). I continued checking them off, preparing to confess my sins to the inquisitor like I had so many times before.
But instead of a perverse and intrusive review of my sex life, I was altogether shocked to be greeted by a relaxed, unfazed doctor who actually seemed to trust that I knew what I was talking about. He told me to have a seat on the exam table, where he felt my lymph nodes to check if they were swollen (which could signal a recent HIV infection). He described the drug and its potential side effects, rambling on about the studies evaluating its effectiveness. I had already read them, but I appreciated his thoroughness and casual tone.
Finally, he asked me why I wanted to take PrEP. I summoned my most clinical-sounding, public health-y voice, and replied, “Well, doctor, I have receptive anal sex with multiple male partners and I use condoms inconsistently.” My experience with well-meaning but easily startled straight healthcare providers has taught me how to conceal my perversity using the veil of science. I’m not sure how he would have reacted if I described my sexual practices in the language I actually use in my daily life. “Well, doc, I just love getting fucked bareback. And fuck its hot when a guy nuts in my ass. I can’t get enough of it.”
After maybe a ten-minute discussion, he simply concluded by saying, “Well, if this is something you want to do, and it sounds like you do, give it a shot.” He turned around to the computer, typed up the prescription, and told me that I needed to head down to the lab for blood-work. They needed to run some tests to ensure my kidneys were in good shape (one of the rare but sometimes reported side effects of Truvada is kidney-related) and they needed to test me for HIV.
Because I knew from my work in HIV prevention that there are different kinds of tests for HIV, I made sure to ask what kind of test he was ordering. While the typical antibody test is extremely accurate, it’s not so good at detecting very recent infections. He had only planned to run the antibody test, but I asked him to run an RNA test as well. The RNA or “viral load” test is better able to detect recent infections, but is less commonly used because it’s expensive and generally less accurate overall. Running these two tests alongside each other might be a good idea to discuss with your doctor before beginning PrEP. After some persuasion, he agreed, and sent me to the lab. I was on my way!
After waiting about a week to get my test results, I called the pharmacy to fill my prescription. I gave them my insurance information and waited silently while they processed the request. I didn’t know whether my insurance would cover Truvada for PrEP. When the pharmacist reported that everything was in order and that I could swing by later to pick up my pills, I was thrilled. “It’s really happening,” I thought.
At the time, I had incorrectly assumed that private insurers might deny coverage for PrEP, but my sources tell me this isn’t the case. While I can’t speak for every private plan across the USA, I haven’t heard of a single instance of someone being denied a prescription – neither has anyone I’ve spoken with during my research for these columns. It’s not even clear if insurance companies can differentiate between prescriptions ordered to treat HIV and PrEP prescriptions intended to help prevent HIV infection.
Have you tried to use your health insurance to cover PrEP? Get in touch! I would love to hear your experiences. Email me at firstname.lastname@example.org. You can read the previous columns in the series at PositiveFrontiers.com.
Jake Sobo is a pen name used for anonymity. Jake has worked in the world of HIV prevention for nearly a decade, and is eager to share his experiences taking PrEP. Having closely followed the development of PrEP from early trials to FDA approval, he was excited to give it a shot when it was approved for use among MSM for preventing HIV.He has spent the better part of his adult life having as much sex as possible while trying to avoid contracting HIV, and started taking PrEP as a way to help him stay negative. He is well aware that the drug is not 100% effective and that he could test positive; while he hopes that does not happen, he knows that he can rely on his numerous HIV-positive friends to deal with that situation should he seroconvert.