Some people think PrEP is expensive and out of reach. But that’s not the case. Most people in Ontario already have a private or public drug plan that will cover all or most of the cost of PrEP. There are also ways for people who don’t have a drug plan to pay for PrEP. Scroll down to learn more about accessing PrEP with different drug plans.
Are you ready to start PrEP but not sure how to pay for it? PrEPStart provides three months of PrEP free for people who do not have a drug plan. It allows you to start PrEP right away and gives you three months to find the drug plan that’s right for you.
Different ways to pay for PrEP
You may already have coverage for PrEP through work benefits, a family member’s coverage or private insurance you pay for yourself.
If you already have private drug coverage through your work or a family member or because you pay for it yourself, your plan likely covers at least some of the cost of PrEP. The amount you pay for a prescription and the amount your insurance company pays depends on your plan.
If you want to know whether your plan covers PrEP and how much it will cost you to fill your prescription, talk to a pharmacist. The pharmacist will need to see the card from your insurance provider and will also need the drug identification number to see if your plan covers that medication.
Here are various brands of PrEP with their corresponding drug identification number:
- Teva-Emtricitabine/Tenofovir: 02399059
- APO-Emtricitabine/Tenofovir: 02452006
- Mylan-Emtricitabine/Tenofovir: 02443902
- Truvada (name-brand): 02274906
- Descovy (tenofovir alafenamide/emtricitabine) DIN: 02454424
If the amount that you have to pay is still high, you may be able to use the Trillium Drug Plan to help with those costs. See “See Trillium Drug Program.”
One option for people who currently do not have drug coverage is to buy a private plan (e.g. Blue Cross, Green Shield) before starting PrEP. If you do not have any pre-existing health conditions, a private plan can be a cheap way to get PrEP. Your provider may be able to refer you to someone who can help you figure out the best drug coverage for you .
The Trillium Drug Program helps people with high medication costs pay for PrEP.
If you don’t have a drug plan or your plan doesn’t cover the full cost of your PrEP, you may be eligible for the Trillium Drug Program:
- If your household’s total annual drug costs are more than 3-4% of your total household income, you can apply to the Trillium Drug Program. Your household income is based on the amount of income you earn plus the income of a partner or any other family member who you support or who supports you financially.
Visitors to Canada can import prescription medications for ongoing treatment directly to their home address in Canada. Online pharmacies are able to get PrEP medications from countries outside Canada for as little as $30 a month. When you are importing medications to Canada, you have to give documents to Canadian Border Services that prove you are a visitor to Canada.
The Ontario Drug Benefit covers the cost of PrEP for Ontarians enrolled in Ontario Works, the Ontario Disability Support Program, home care or community care programs.
If you are enrolled in Ontario Works, the Ontario Disability Support Program, home care or community care, then you have coverage for a variety of medications, including PrEP, through the Ontario Drug Benefit program.
- When you fill a prescription, show your OHIP card to the pharmacist and you will only have to pay up to $2 each time you fill a prescription.
OHIP+ covers the cost of PrEP for Ontarians 24 years old and younger with a valid OHIP card and no private drug coverage.
If you are 24 years old or younger, have a valid OHIP health card, and do not have private drug coverage, you are automatically covered by OHIP+. Show your OHIP card to the pharmacist and you will only have to pay up to $2 each time you fill your prescription.
As of April 1, 2019, OHIP+ will not cover the cost of PrEP for Ontarians 24 years old and younger who already have private drug coverage. Learn more about OHIP+ here.
Ontarians age 65 and older who have a valid OHIP card are covered for PrEP.
If you are 65 years old or over and have a valid OHIP card, you are covered by Seniors Coverage.
This program provides different levels of coverage based on your household income:
- If you are single and earn $19,300 or less after taxes or you are part of a couple with a combined yearly income of $32,300 or less after taxes, you will pay up to $2 each time your fill your prescription.
- If you are single and earn more than $19,300 after taxes or you are part of a couple with a combined yearly income of more than $32,300 after taxes, you will pay the first $100 of all your prescription costs per person each year and then up to $6.11 for each prescription filled or refilled.
People using the Interim Federal Health Program in Ontario are covered for PrEP.
If you are enrolled in the Interim Federal Health Program (IFHP) you have coverage for a variety of medications, including PrEP. IFHP only covers your medication costs if you do not have coverage through another government drug program or through private insurance.
- When you are filling a prescription, show your IFHP coverage document to your pharmacist.
People eligible for the Non-Insured Health Benefits program are covered for PrEP.
The Non-Insured Health Benefits program is only open to some Indigenous people with specific legal status in Canada, including First Nations people registered as an Indian under the Indian Act or Inuks who are recognized by an Inuit Land Claim organization. Note: NIHB only covers your medication costs if you do not have drug coverage through another government program or through private insurance.
- If you think you might be eligible or want more information to see if you can apply, contact the Ontario regional NIHB office at 1-800-640-0642
Canadian Armed Forces personnel are covered for PrEP through Canadian Forces Health Care.
If you are a member of the Armed Forces, you can access PrEP through the health coverage you have as part of serving. If health care providers at your base, wing or unit are not willing to prescribe PrEP, you can use your Canadian Forces Health Care Identification card (sometimes called a Blue Cross Card) at off-base clinics to access PrEP and at community pharmacies to pay for PrEP and other prescriptions.
- If you do not have a Canadian Forces Health Care Identification card, call 1-866-886-1304 to ask about acquiring one. You do not have to say you plan to use your card to access PrEP.
Veterans Affairs Canada (VAC) health benefits will cover the cost of PrEP for veterans who are enrolled in VAC health programs, such as Long-Term Care, Disability Benefits, the Veterans Independence Program or the War Veterans Allowance with Veterans Affairs Canada.
When you visit a pharmacy to get your medication, bring your VAC card. The pharmacist will bill the cost of your medication and any dispensing fees directly to VAC.