Paying for PrEP in Ontario
The cost of PrEP has changed dramatically since the Truvada brand is no longer the only approved PrEP medication in Canada. Now generic versions of Truvada (think a facial tissue that’s the exact same as Kleenex but not called Kleenex) – with the same medications as Truvada – are much more affordable at roughly $250-$280/month. Descovy is another brand name drug and is still pricey since its generic versions aren’t available yet. Without insurance Descovy costs $1000/month.
Whether your bill is $250 or $1000, there are options to help you pay for PrEP:
Public Insurance Plans
Both Canadian and Ontario public insurance plans cover many antiretroviral medications. These plans include: federal plans provided to Canada’s Indigenous communities, people with refugee status, and Canadian Armed Forces personnel. Talk to a pharmacist or your doctor for more information. To find out more about public insurance plans see our “” page. Many of the federal drug plans cover Truvada and its generic versions, but these plans do not cover Descovy. For coverage of Descovy, you’ll need a private insurance plan through your work, family, or spouse.
Important note: There has been one public drug plan that was specifically created for PrEP! PrEPStart provides three months of free PrEP for people at risk of HIV who do not currently have drug coverage. This plan lets them start PrEP right away and gives them three-months to arrange drug coverage so they can stay on PrEP as long as needed. Find out more https://ontarioprep.ca/prepstart/
First consider if you can use a public plan, possibly even in conjunction with a private plan. Secondly, if you have a partner consider if either of you have an insurance plan with drug benefits that both of you could use. Many people may not have their own policy, but may have some form of coverage through their partner or another family member.
Read over your insurance benefits policy. Look for drug coverage, which is usually listed as “extended healthcare benefits”. See our Private Insurance Worksheet for guidance. Do not expect your pharmacist to know your plan.
Once you read through your plan, you must understand the limits of your drug coverage. Write them out in plain language and note where it is found in the policy. (It is easy to forget this information.) Noting it will save you a great deal of time searching for it again. Many insurance companies have websites or apps which can make it easier to look up specific details.
Examples of limits in a policy:
- There may be a lifetime expense limit, or maximum expense limit for a specific time (e.g. 1-year).
- There may be refill limitations in place. This restricts how often you can refill a prescription in a given period of time.
- The policy might only partially cover the cost, such as 60% of drug costs. Even partial coverage makes PrEP more affordable; for example, paying $400 a month (because the insurance plan pays 60% or $600) for Descovy is a lot better than paying $1,000.
There are likely to be other qualifying basic criteria for drug coverage such as: “…only on a prescription,” “when prescribed by a physician…” or “…dispensed by a pharmacist, physician…” This is standard in almost all plans.
For more information see: Private Insurance for PrEP.
What Costs Do PrEP Providers Cover?
What has emerged in Ontario and other parts of Canada has been specialized PrEP providers who have assembled teams of people who can prescribe, dispense and monitor health for people taking PrEP. In many cases they have also created business models that pick up some costs associated with PrEP. When shopping around for a provider always ask about how the costs and payments will work and what happens if you run out of coverage or are dealing with deductibles.