Truvada is a medication that belongs to a class of drugs known as antiretrovirals. A doctor may prescribe this medication to treat or prevent HIV infections.
If a person has original Medicare, prescribed medication coverage is available through a Medicare Part D prescription drug plan (PDP).
Medicare Advantage plans usually include prescription drug coverage.
However, Truvada is not usually free or low-cost. This article will explain how Medicare covers Truvada and steps a person can take to reduce their costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare requires that all PDPs cover all antiretroviral medications, including Truvada.
According to the Kaiser Family Foundation, more than 36,000 people with a PDP used Truvada in 2017, spending more than $416 million.
There may also be some out-of-pocket expenses associated with the costs of Truvada.
Which parts provide coverage?
Medicare requires that all enrollees have a form of creditable prescription drug coverage. This means a person must have at least as much prescription drug coverage as the most basic Medicare PDP.
Two methods can help a person obtain a PDP. The first is to purchase a Part D plan from a private insurance company.
The second is to select a Medicare Advantage plan (also known as Medicare Part C) that includes prescription drug coverage.
Either option can help a person obtain Medicare coverage for Truvada and other medications.
Truvada is a brand name for the medications tenofovir disoproxil fumarate and emtricitabine.
It is a once-daily combination-medication that keeps viruses from infecting the body. Doctors prescribe Truvada for its ability to reduce as well as prevent viral infections.
On the prevention side, doctors prescribe Truvada as a “pre-exposure prophylaxis” or PrEP approach. This means that taking this medication may help to prevent HIV.
If taken exactly as prescribed, Truvada may help to prevent up to 99% of HIV infections, according to the American Journal of Public Health.
For those who have HIV, taking Truvada may help reduce the rate at which the virus replicates. As a result, a person will ideally have fewer symptoms associated with the illness.
Truvada consists of two medications combined: tenofovir disoproxil fumarate (TDF) and emtricitabine.
The patent for TDF has expired, but the emitricitabine patent does not expire until September 2021. However, Gilead Sciences, the makers of Truvada, granted exclusive rights to a company called Teva to produce a generic version of Truvada beginning October 2020.
Because there is only one competitor to Truvada, the generic drug is not significantly cheaper than the brand-name drug.
When the patent for all of the drug components expires, more companies may produce a generic version of Truvada. This production could help lower the medication cost.
If a person were to pay for Truvada out-of-pocket, the medication would cost on average $2,000 per month, according to the American Journal of Public Health.
Many factors can affect the price of Truvada, including:
- the type of drug plan a person has
- the private insurance company that administers the plan
- if a person also has Medicaid coverage
- if a person has supplemental security income (SSI)
If an individual has a standalone PDP, PrEP medications in general (not just Truvada) have an average annual cost of between $2,276 and $2,430, according to the American Journal of Public Health.
The average annual cost for a person with a Medicare Advantage plan that includes prescription drug coverage is estimated between $1,354 and $2,277.
Prescription drug plans will usually separate medications into tiers or pricing categories ranging from preferred generic, which are the least expensive medications, up to brand-name or specialty medications, which are high in cost.
Truvada currently belongs in the high-cost category as it is a brand-name drug.
When a person has Medicare Part D coverage, they are responsible for several costs associated with their plan and paying for medications.
These costs include:
- Monthly premium: The amount of a monthly premium depends on many factors, including plan provider, and additional support eligibility.
- Deductible: For 2021, no Medicare drug plan could have a deductible higher than $445.
- Copayments/coinsurance: After meeting their deductible, a person may pay a portion of the prescription drug’s cost, known as a copayment or coinsurance.
According to GoodRx, an independent prescription drug pricing site, a person can expect to make the following payments for Truvada for a 30-tablet (30-day) supply:
Before the deductible is met, a $54 to $68 copayment is expected. After the deductible is met, a $13–$68 copayment is typical.
These estimates represent averages. Some people may pay more for Truvada while others will pay less.
The Food and Drug Administration (FDA) heavily regulates generic medications to ensure their safety.
They require generic medications to have the same dosage, strength, quality, and route as brand-name medications.
If a person starts to take generic Truvada and is concerned about a new side effect, they should talk to their doctor.
Other options exist to help a person pay for the costs of antiretrovirals like Truvada. This includes the following:
- AIDS drug assistance programs: Also known as ADAPs, state-based programs help low-income individuals pay for out-of-pocket costs. Examples include help with copayments, coinsurance, deductibles, and premiums.
- Extra Help: Extra Help is a Medicare-sponsored program for those with limited incomes and resources to receive additional financial help with paying for medications. Extra Help can mean a person pays no more than $9.20 in 2021 for a brand-name drug like Truvada.
- Medicaid: Medicaid is a federal- and state-sponsored program that helps low-income individuals receive help in paying for insurance costs, including prescription drugs.
- Gilead Advancing Access: Gilead, Truvada’s manufacturer, has a program called Advancing Access that assists insured, non-insured, and under-insured individuals. The program can assist in finding ways to make Truvada more affordable whenever possible.
A person can also speak with their doctor about potential local assistance programs that can help pay for Truvada.
All Medicare prescription drug plans cover Truvada.
However, a person is still responsible for costs such as plan premiums, copayments, and other out-of-pocket expenses.
Fortunately, there are assistance programs available that can help make the medication more affordable and easier to access.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
We will update the 2021 costs as soon as possible after the Centers for Medicare and Medicaid Services (CMS) have released them.
We last updated the costs on this page on October 28, 2020.