The Human Immunodeficiency Virus, better known by its acronym HIV, is responsible for AIDS. It attacks the immune system and seriously compromises the health of the individual. There is currently no effective cure, although medicine is constantly advancing in the search for a treatment that will suppress the disease from the body.
Although there is no cure, HIV has a series of special treatments to keep the virus regulated within the body and different prevention methods. One is Post Exposure Prophylaxis (PEP), a combination of antiretroviral drugs that work as a prevention agent. In this guide, we will learn about PEP, how it works, when to take it, how much it costs with insurance, and how much PEP is without insurance.
What is Post Exposure Prophylaxis (PEP)?
Post Exposure Prophylaxis (PEP) is an antiretroviral drug that works like an “emergency pill.” The idea is to use it when you suspect you have HIV. If taken as directed, the treatment is considered effective in preventing virus transmission.
As the name implies, PEP is a drug that prevents the virus from replicating in the body after exposure, never before exposure. This combination of antiretrovirals has this composition for adults:
- Tenofovir/ emtricitabine (Truvada) with raltegravir (Isentress)
- Tenofovir/ emtricitabine (Truvada) with dolutegravir (Tivicay)
Some of the situations in which one should take PEP include the following:
- Having consensual sex without using a condom or other barrier method or if the protection method broke during the act
- Being a victim of sexual assault
- Sharing needles or syringes to inject drugs or other substances
- Having an occupational injury such as having received a needle stick or a cut
It is imperative to keep in mind that PEP only works as an emergency pill. You cannot substitute it for other prevention methods, such as condoms or Pre-Exposure Prophylaxis (PrEP).
What is the cost of PEP without insurance?
Medicaid and most insurance companies cover PEP. The uninsured cost of treatment is $600 to $1,000 for one pill. The patient has to consider that this is only the payment for the pill; more money is needed to consider other expenses inherent to the process.
To find out what the cost is with your insurance company, you should first contact your consultant and verify that PEP is covered. After confirming, you can request a quote for the treatment. If you do not have an insurance company, many pharmaceutical companies offer a “Patient Assistance Program” to help pay for PEP.
If a physician prescribes PEP for a patient following a sexual assault, they may be eligible for partial or full reimbursement, as directed by the Office of Victims for Crime. It is important to consider that this rule may vary depending on the state where you are located.
In most cases, some patients will not have to pay for PEP. For example, if a doctor is exposed to HIV during work, the employer’s insurance company or workers’ compensation program pays for the pill. Depending on your case, you will either have a percentage or no coverage.
How do you qualify for PEP?
To access the pill, you have two options: go to a doctor to receive a prescription or go to an emergency room near you. The first option is to go to a health care provider, a local sexual health clinic, or a physician. It is important to mention that you should choose a provider you trust; before prescribing PEP, they will ask a series of questions regarding your sexuality and drug use that you should answer honestly.
If the first option is not feasible because sexual health clinics are closed, or you cannot find a doctor who can treat you on an emergency basis, you have the alternative of visiting an emergency room. These rooms are in hospitals, so it is recommended that you exhaust all resources before considering this option.
What can I expect when I ask for PEP?
The healthcare provider will discuss filling out a medical history with you. You will have to answer specific questions about your exposure to HIV, such as time, date, place, and manner of exposure. With this information, the specialist will evaluate whether you are eligible to take the pill.
The doctor will test you for HIV to determine if you are still HIV-negative. If it is negative, PEP will be prescribed, and you will be able to buy it. Still, if it is positive, it means that the virus has taken the body, so the professional will proceed to establish a treatment plan to control the infection.
To establish the complete plan, you will be asked to contact the person who infected you to determine what your HIV status is and what treatment you are currently undergoing. This information is essential and may change the primary treatment.
Your provider may ask you to have additional testing for other Sexually Transmitted Diseases such as hepatitis C and to receive vaccinations for other conditions such as hepatitis A and B. You will also need a pregnancy test to determine if you have HIV. You will also need to take a pregnancy test or use emergency contraception. The idea is to establish a definite plan for you to decrease the risk of exposure in the future.
If you receive PEP with insurance or self-pay, the provider will explain how to take it over your lifetime. You will be given the prescription and take it as directed. If you receive the pill in an emergency room, you may be given the first dose and other pills to cover a few days of treatment. Within this time frame, you will need to come up with the money to cover the rest of the process.
How to take PEP?
When you receive the first drug dose, you must take it following the strict indications of the specialist. PEP is taken daily for 28 days; suspending or omitting it can be dangerous; if you decide to do so, you risk it not working. It can also interfere with its effectiveness with other medications; you must discuss other pills you take regularly with your doctor.
At the end of the 28 days defined by the doctor, you should take an HIV test and confirm that it is negative. It is important to visit the doctor to evaluate your condition and to repeat the test in three months to corroborate the result. You will need to maintain a process of regular medical visits until the doctor confirms that you are now safe from the virus.
If you are wondering how effective PEP is after 24 hours, the answer is that you must take the pill within 72 hours after exposure. Every hour counts, and the recommendation is to take it before 24 hours to receive immediate care.