How to Buy PrEP: the methods and obstacles to Buy PrEP in 2020?
*In this article, we will be discussing how to buy PrEP in 2020, the platforms available and the whole topic of PrEP around the world.
Introduction
Although we are 4 decades after the HIV outbreak of the 1980s, the world is still suffering from new HIV infections every year. This burden is not only a public health burden but also a social and economical one.
These infections can turn into local epidemic outbreaks among certain risk groups in developed countries. On the other hand, Developing countries are still struggling with HIV outbreaks as preventive measures, education, testing, and medical therapies are still not available for many people in these countries. The Prevalence of HIV in Africa is still among the highest worldwide.
For example, in South Africa, around 20 percent of the population are carriers. As a result, a considerable share of the country’s GDP is occupied by HIV related health services (1).
HIV spread around the world
An estimated 1.7 million individuals worldwide became newly infected with HIV in 2018 (1).
As for 2018, around 37.9 million people across the are considered HIV carriers(1).
The next question might sound very ambitious as we live in the COVID-19 era and the pattern of flattening of the disease curves is, for now, the best-case scenario.
However, we believe that we are in a different phase with HIV. Therefore, we will be bold and will raise the following question:
Can we eradicate HIV?
Most of the diseases that we managed to eradicate in the past century have been eradicated by a potent vaccine ( Mumps, Measles, Rubella, etc).
A vaccine seems at first glance the best solution.
However, it is not possible, due to the nature of HIV that infects our CD4 T-helper cells (an integral part of our immune system) affecting our immune response against it.
In addition, the virus is able to remodel and change its molecular appearance frequently.
However, In 2012, the first HIV pre-exposure prophylaxis (Truvada) medication was approved by the FDA (2). Truvada was able to represent high percentages of success in preventing HIV infections when administered before exposure following certain protocols.
In some studies, Truvada reached a 99% success rate (3).
High preventive rates like this made many medical experts and scientists aspire that we might be able to eradicate or nearly eradicate HIV.
However, since its introduction, the incidence of HIV around the world has not changed significantly and this raises the following question:
Is PrEP accessible?
The short answer is no. Even in developed countries up to this date, it is quite difficult and costly to access PrEP.
An interesting study in France asked: “Are PrEP services in France reaching all those exposed to HIV who want to take PrEP?”.
The researchers concluded that although PrEP is provided for free by the government for certain risk groups, it doesn’t reach the whole target population. This, according to researchers, is due to the fact that the many risk groups that should be eligible for PrEP are excluded. And if they are not excluded, the process to acquire the prescription for PrEP and get enrolled in a governmental program can be tiring. An additional reason that was demonstrated in this study was the fact that it’s difficult for people that live outside of large cities to have access to it, as they need to travel long distances to be part of such programs.
Researchers suggested that a more universal and easy approach is needed so the medication reaches to the whole target population and serves its goals (4).
How easy is it to get PrEP in the USA?
The US doesn’t have a single-payer health care system. Therefore, the price of the PrEP and the kind of health insurance program you, have, can be a detrimental factor in your ability to access the therapy.
In a recently published research at the American public health journal, the authors ran an analysis of various researches regarding the question:
Is Insurance a Barrier to HIV Pre-exposure Prophylaxis? (5).
In some studies that analyzed the role of the cost of PrEP and health insurance in the adherence to PrEP therapy, it appeared that these factors played a smaller role. In one study young black MSM tended to consume PrEP less often even if delivered for free (6). This was believed to be attributed to the fact they didn’t believe they are part of a risk group.
We can conclude that PrEP education, especially among risk groups, is a very important means for approaching them.
However, most of the researches that analyzed this matter concluded that the cost to buy PreP and the type of medical insurance played a major role in PrEP therapy adherence. In a survey that included 138 injection drug abusers, around a third reported lack of insurance as a barrier to PrEP use (7). In another study that investigated reasons for PrEP discontinuation among gay and bisexual men, 30% of participants cited the high cost of prescription copays as a reason (8).
We believe that high prices are among the main reasons that PrEP is not accessible to many populations around the globe.
Costs and insurance plan’s cover of PrEP in the USA:
Preexposure Prophylaxis Payment Options and Associated Costs
| Health Payer | Health Payer Type | Eligibility | Average Cost or Rebate Per Year |
| Medicaid | State-administrated public insurance program | Medicaid expansion states only: ≤ 138% of the FPL for adults aged 18–65 y | Nearly free for Medicaid enrollees with incomes < 150% FPL |
| All states | |||
| Low-income parents and their children | |||
| Pregnant women | |||
| People with disabilities | |||
| Low-income seniors aged ≥ 65 years | |||
| Medicare | Federal public health insurance program | Aged ≥ 65 years | Varies by state or county and plan |
| Receives Social Security Disability Insurance | Prescription drug plan example: $2276–$2430 (including deductibles, monthly premiums, copays, and coinsurance) | ||
| Private insurance | For-profit insurance plans sold by health insurance companies | Enrolled in a commercial insurance plan | Varies by state or county and plan |
| Spouse or dependent of someone enrolled in a commercial insurance plan | Low deductible plan example: | ||
| $162–$243 for year’s supply | |||
| $500 deductible | |||
| 20% coinsurance fee after deductible | |||
| Gilead Advancing Access | Federal drug assistance program | Uninsured | Free for uninsured individuals |
| Commercially insured | Up to $4800 rebate for commercially insured individuals per year | ||
| Patient Advocate Foundation’s Co-Pay Relief Program | 501(c)(3) nonprofit drug assistance program | Insured individuals with annual incomes < 400% FPL | Up to $7500 rebate for drug costs per year |
| PrEP Drug Assistance Program | State drug assistance program | Uninsured or underinsured PrEP users living in Washington, Colorado, New York, Illinois, or Massachusetts | Free for low-income individuals (FPL limit varies by state) |
Note. FPL = federal poverty level; PrEP = preexposure prophylaxis. Total costs for insured users may vary by state, county, and plan.
Where Can I buy PrEP?
In most countries, PrEP is a prescription drug and there are many criteria you need to meet in order to be eligible for this therapy. However, due to the high cost, difficult requirements and long bureaucracy, Many people, as mentioned above, are not able to access PrEP therapy through the healthcare systems. To address these issues, many non-governmental organizations, non-profit organizations, and LGBT organizations came with an initiative to provide PrEP for free for those who are in need and can’t access it.
Are NGOs and civil non-profit organizations able to compensate?
These organizations have limited resources and are not able to address the real demand for PrEP.
In the US, according to official health reports, more than 1 million people are eligible for PrEP and should consume it before any unprotected, sex activity, however, according to Prepwatch, there are only around 150 thousand registered active users of PrEP in the United States that buy PrEP from the official platforms.
Subsequently, more than 80 percent of people that should be able to buy PrEP but they are not.
Worldwide the problem is even worse, nowadays, the number of PrEP users around the world is only 380 thousand, while tens of millions should be consuming PrEP around the world according to research(9).
People buy PrEP online
As a result of the high demand and, the low availability, there is a growing demand, on PrEP online.
Many medical doctors and many organizations included in their follow-up programs patients that acquired the medications from online pharmacies.
A UK research at a national STD prevention clinic demonstrated that many of the regular follow-up patients (that visit the clinic for ordinary STD survey checks) have acquired the medication online (10).
Because health practitioners understand the need of some risk groups like MSM, sex workers, and IV drug users for chronic PrEP use, They tend in many cases to point the patients to these online pharmacies to acquire PrEP.
Moreover, the availability of PrEP, even in developed countries is still limited (check the statistics above).
Why Buy PrEP online?
PrEP is, relatively, a new medication. Therefore, it’s legal status around the world varies widely.
As you can see in the map below, in some places only Truvada is approved for use. Moreover, in other countries generics are approved, while in other PrEP is still in regulatory processes.
This makes online sources a more safe and consistent supply source for many people around the globe.
Furthermore, PrEP’s Price can be very high and a limiting factor in many developed countries. For Example, the USA has a high price obstacle, as it lacks a single-payer health care system.
However, in many countries, regulators limit the eligibility for PrEP to extreme cases in order to lower governmental spending.
For example, If you look-up the low numbers of PrEP’s consumption in the EU countries, you can understand that the reason is most probably the regulatory difficulties authorities impose on seekers.
To check the numbers of PrEP users around the world Click here.
How much it costs to buy PrEP around the world?
Country |
TruvadaCost/month |
Generic PrEPCost/Month |
USA |
1300$-2000$ |
Available in 2020 |
France |
400 Euro |
160 Euro (190$) |
UK |
£500 |
Online for around 30 £ |
Africa |
– |
60$ |
Canada |
800 $ |
250 $ |
Australia |
850$ |
130$ |
Germany |
1500$ |
Free for certain groups *As of September 1, 2019, people in Germany from the age of 16 with a substantial HIV risk can get PrEP (Pre-exposure prophylaxis) for free, covered by the statutory health insurance. |
Another factor that we would like to address here is cultural values. In many cultures and in many countries, HIV, STD’s and sex practices are not addressed openly in society.
Consequently, many people, at risk, groups, are shy or uncomfortable with going to the local medical practitioners in order to ask for PrEP, as they will need to expose their sexual practices in many cases.
This situation, in some countries, can get more extreme, and in some cases put their life, family or workplace in danger.
Consequently, PrEP as an exceptional therapy has a high demand at online pharmacies as they obviously address various needs.
Why is an easy to buy PrEP an economic interest for the government?
Lately, PrEP is becoming available around the world as generic PrEP is introduced in many countries.
However, we are far from approaching the ultimate goal of PrEP in preventing new HIV infections and ultimately eradicating HIV, as Governmental expenditure on PrEP is still low.
It has been estimated that the average lifetime cost to the NHS (UK) for a person living with HIV is £360,000. Around two thirds (68%) of these costs were for anti-HIV drugs. The cost of a year’s HIV treatment is about £11,000 (11).
In short, governments and health systems can benefit economically from subsidizing PrEP therapy.
Conclusion
Up to this date, PrEP is still not available worldwide both in developed and developing countries alike. Less than 10% of the world’s population eligible for PrEP actually consumes it.
Consequently, many creative solutions such as online pharmacies, NGO’s and LGBT organizations have contributed to the spread of PrEP around the world helping in balancing the shortages.
To some up, we expect in the next years, millions of people around the world to start consuming PrEP.
Many generic forms are becoming available at lower prices. As a result, we expect that governments will ease the restrictions on subsidizing PrEP therapies.
Resources:
- https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics
- https://www.cdc.gov/nchhstp/newsroom/2012/fda-approvesdrugstatement.html
- https://www.nejm.org/doi/full/10.1056/NEJMoa1011205
- https://www.tandfonline.com/doi/full/10.1080/09540121.2020.1739219
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893325/
- https://www.ncbi.nlm.nih.gov/pubmed/28708811/
- https://www.ncbi.nlm.nih.gov/pubmed/29465703/
- https://www.ncbi.nlm.nih.gov/pubmed/29404756/
- https://www.aidsmap.com/news/oct-2018/380000-people-prep-globally-mostly-usa-and-africa-updated
- https://www.ncbi.nlm.nih.gov/pubmed/30249318
Great article. Can you explain the risks of PrEP?
It is not that clear..
Hello John, thanks for your comment.
Sure. PrEP in its form of TDF/FTC can have renal side effects, thus we recommend you check your kidney blood functions before taking PrEP (Blood Creatinine and Urea). Read more about it in Step 2 of our Guide.
PrEP can cause HIV resistance to treatment if taken by HIV positive patients.
PrEP can cause refractory hepatitis if taken in people with a positive profile of hepatitis.
For more information regarding side effects please read our step 3.
Kind regards,
Dr. Matani