Truvada is a prescription medication used to treat and reduce the risk of acquiring HIV-1. It contains two antiretroviral drugs – emtricitabine and tenofovir disoproxil fumarate. When taken daily, Truvada is over 90% effective at preventing HIV transmission between partners if one partner has HIV and the other does not. It also reduces viral load and improves immune function in those living with HIV when combined with other antiretroviral therapies.
However, Truvada can be an expensive medication. Without insurance, 30 tablets of Truvada can cost over $2000. Even with insurance coverage, copays can present financial challenges for those that need this important preventative treatment. Fortunately, Gilead Sciences, the manufacturer of Truvada, offers a patient assistance program and copay card that significantly reduces costs. There are also state, federal, and Medicare programs that provide financial assistance.
Who Qualifies for Truvada Discounts
The key Truvada discount program and patient assistance programs have specific eligibility criteria interested applicants must meet. These include:
Income Requirements – Most programs set maximum income thresholds aligned to a percentage of the Federal Poverty Level. You must demonstrate financial need to qualify.
Insurance Status – Some assistance is reserved for uninsured or underinsured patients. However, those with public or private insurance may still receive copay or medication cost assistance.
Medical Necessity – Applicants need a prescription indicating Truvada is medically necessary for the prevention or treatment of HIV-1. Diagnosis, lab work, medical records or a physician letter may serve as documentation.
Residency – U.S. citizenship or permanent residency is required for most programs.
Application Process – You will need to complete an application with personal information and financial documentation. Plan to reapply annually or when your eligibility lapses.
Ensuring you meet the eligibility criteria is an important first step before applying to any Truvada financial assistance program.
Truvada Patient Assistance Program
The Truvada Patient Assistance Program offers free medication to uninsured and underinsured patients that meet income requirements. Patients with insurance may also qualify if they are struggling with copays or deductibles under their plan’s prescription coverage.
To qualify for the Truvada patient assistance program in 2023, you must:
- Have a household income at or below 500% of the Federal Poverty Level
- Have a valid prescription for Truvada for pre-exposure prophylaxis or in combination with other antiretroviral therapies
- Be a resident of the U.S. or a U.S. territory
You will need to provide personal information, your household income, a valid Truvada prescription, and evidence you have been denied by Medicaid to complete the application.
If approved, you can receive Truvada medication for free from the manufacturer. You may need to reapply annually or sooner if your eligibility changes.
Truvada Copay Card and Coupons
The Truvada Copay Card is available to commercially insured patients, including those with copays or coinsurance costs under Medicare Part D plans. It covers up to $7,200 per year in prescription copay costs which helps significantly lower the out-of-pocket costs associated with brand name drugs.
To be eligible, you must:
- Have commercial insurance or Medicare Part D coverage
- Have an out-of-pocket copay responsibility for Truvada
- Not qualify for low-income subsidy under Medicare
- Have a valid prescription for Truvada
You can enroll easily on the copay card website or by calling the number on the back of your Truvada savings card provided by your pharmacist or doctor.
Using the copay card is straightforward – just present it at the pharmacy counter each time you fill your Truvada prescription. The discount will be automatically applied to reduce your copayment amount.
You can also access savings through a SingleCare prescription savings card or by using websites like GoodRx and WellRx to search for Truvada coupon codes good towards 30-day fills of the medication. Compare pricing between retailers and programs to maximize how much you can save.
State and Federal Truvada Assistance Programs
In addition to the Gilead assistance programs, there are state and federal programs that provide help with affording Truvada treatment and PrEP use for qualifying applicants.
These include:
- AIDS Drug Assistance Program (ADAP) – ADAP serves uninsured and underinsured individuals living with HIV/AIDS by providing medications, insurance assistance, and other support services. Truvada for treatment, when prescribed with other antiretrovirals, is included in the ADAP formulary. Each state operates their own ADAP program with eligibility criteria aligned to resident status, income thresholds, insurance status, and CD4 counts.
- Medicaid – Medicaid insurance plans in many states have good prescription drug coverage that wraps in Truvada when medically necessary. You must meet program income limits and other eligibility factors. Many states expanded their Medicaid programs under the Affordable Care Act.
- Medicare Part D – Medicare Part D plans cover HIV medications including Truvada. Low income seniors and younger patients with disabilities can access Part D plans with subsidized premiums and reduced copays when they qualify for Extra Help.
Check with your state health department to learn about ADAP and Medicaid resources in your area. Use the Medicare Plan Finder to compare Part D plans. Enrolling in subsidized coverage or public assistance programs can significantly reduce overall out-of-pocket costs towards Truvada.
Medicare Coverage for Truvada
Under Medicare Part D, Truvada for both HIV treatment and PrEP use is covered by all plans nationally as part of the defined standard benefit structure. This means any Medicare drug plan you enroll in will include Truvada on its formulary. You will have a set copay or coinsurance when you fill the medication at an in-network pharmacy.
Here is how Medicare covers Truvada in 2023:
- Deductible Stage – This year the standard deductible is $505. You must pay 100% medication costs out-of-pocket until you hit this amount. Then your copays or coinsurance kicks in. Some plans have lower or no deductibles.
- Initial Coverage Stage – During this stage, your Medicare plan covers 75% or more of your total prescription medication costs — including Truvada. You will owe a 25% coinsurance or a flat copay amount to fill a 30-day or 90-day prescription.
- Coverage Gap (“donut hole”) – The gap begins after total drug spend hits $4,660. You enter catastrophic coverage with just 5% coinsurance once you hit the Medicare out-of-pocket threshold of $7,400. This provides protection for seniors with high Rx costs like HIV and hepatitis meds.
- Truvada Copay Card – You can use copay cards from drug manufacturers like Gilead to lower your out-of-pocket costs at the pharmacy counter. The Truvada copay card is valid to use under Medicare Part D plans.
- Extra Help – Low income seniors and under 65 patients with disabilities can qualify for Medicare’s Extra Help program. It provides financial assistance through subsidies that lower Part D premiums, deductibles and RX copays – including costs applied towards fills of Truvada.
Talk with your Medicare plan about your Truvada coverage details and costs specific to the plan you enroll in. Use tools like the plan finder to accurately compare options for Medicare drug coverage from providers in your region.
Applying for Truvada Discounts and Finding Additional Support
If you are prescribed Truvada as an HIV preventative or for use in antiretroviral therapy to manage an HIV diagnosis, explore all the financial assistance options available:
- Learn if you are eligible and apply for the Gilead patient assistance program or Truvada copay card
- Check requirements for ADAP and Medicaid in your state
- Research Medicare Part D plans that will meet your Truvada and other prescription medication needs
- Work with medical bill assistance programs and non-profits like ViiV Connections and NASTAD that support costs for uninsured patients
- Connect with an AIDS service organization or case manager for help navigating programs and accessing support services
- Talk to your doctor and pharmacist about any coupons or savings programs that can lower your out-of-pocket costs
Budgeting for Truvada treatment and pre-exposure prophylaxis can be expensive even with insurance. But there are more resources than ever to provide copay, coupon, and financial assistance towards this first-line HIV prevention and management medication. These programs make PrEP and life-saving antiretroviral treatment more accessible and affordable for vulnerable patients and communities impacted by the HIV epidemic.
Conclusion
Truvada can reduce the transmission and complications of HIV infections when taken as prescribed. However, the high cost of this brand name drug presents barriers to access even for patients with health insurance. Fortunately, Gilead Sciences and government assistance programs provide much needed financial relief that make Truvada more affordable for uninsured, underinsured and low-income patients.
Discounts like the Truvada copay card and patient assistance program greatly reduce direct out-of-pocket costs. Medicare Part D also includes HIV drugs like Truvada as part of the defined standard benefit. And resources like ADAP subsidize costs for qualifying patients based on need. Anyone needing help paying for Truvada should complete an application to see if they meet eligibility requirements for these financial assistance programs. Significant savings is available in 2023 to remove cost concerns around taking this important prevention and treatment medication.
Frequently Asked Questions
What out-of-pocket costs does the Truvada copay card cover?
The Truvada copay card covers up to $7,200 per year in prescription copay or coinsurance costs. This can include Medicare Part D expenses or commercial plan copay amounts towards 30-day or 90-day fills.
Who provides Truvada for free through patient assistance?
The manufacturer Gilead Sciences operates the Truvada patient assistance program providing the drug for free to uninsured, underinsured and low-income applicants. You must meet income eligibility thresholds and other requirements to qualify.
Does Medicare Part D cover Truvada?
Yes, Medicare Part D includes Truvada coverage as one of the national formulary HIV antiretroviral medications. All Medicare drug plans must include Truvada on their plan formulary and cover its medically necessary use.
Can I use the Truvada copay card if I have Medicare?
Yes. Medicare Part D plan enrollees that pay a percentage coinsurance or flat dollar copay amount toward Truvada can take advantage of the Gilead copay card to reduce those pharmacy costs.
What if I still cannot afford Truvada with insurance?
There are medical bill assistance programs through non-profits and AIDS service organizations focused on making sure patients get the HIV medications they are prescribed regardless of ability to pay. Connect with case managers and social workers for help applying to available financial support programs.
