INSURANCE FOR PrEP
Wondering whether your insurance plan will cover PrEP? Find out more about coverage for PrEP in Ontario.
Is PrEP Free?
PrEP may be free for some people in Ontario who are on the Ontario Disability Support Plan, Ontario Works, are over the age of 65, or have 100% coverage through a personal or employee health benefits plan.
If you are 24 years old or under, and you do not have health insurance through your parents plan, employer or school, prescription medications - including PrEP, PEP and HIV medications - are free under OHIP+. Just remember to bring in your health card to the pharmacy when filling your prescriptions.
If you're over 25 years old and don't qualify for OHIP+ and you don't have a health insurance plan, you can apply for the Trillium Drug Program.
For added reference, here's the ACT 1-pager on coverage for PrEP.
Will my Insurance Plan cover PrEP?
If you have a prescription for PrEP, it will likely be covered by your employer’s insurance plan. Most employee health benefits plans cover a portion of the cost of prescription medications. The portion covered can range from 50% to 100%, with most benefits plans in the 80% coverage range.
If you have a 'Pay Direct' card provided to you by your employee benefits plan, you call us at The Village Pharmacy and we'll tell you how much coverage you have, and what your out-of-pocket costs will be.
As new generic versions of Truvada enter the market in Ontario, it may take some time for insurance companies to list the drug on their formularies. It’s best to check with your insurance provider to see if generic PrEP is covered.
You can find out for sure by contacting your Insurance provider directly. They may ask you for the Drug Identification Number (DIN) to check coverage. See the common DINs for PrEP for reference.
Drug Identification Numbers
Drug Name / Drug Identification Number
Truvada (brand name): 02274906
Apo Emtricitibine-Tenofovir: 02452006
Mylan Emtricitibine-Tenofovir: 02443902
Teva Emtricitibine-Tenofovir: 02399059
PrEP Coverage for youth, college & university students
All children and youth under the age of 25 with a valid Ontario Health Card and no other private insurance, will have all their medications covered. So, if you are under 25 years of age, and you'd like to start PrEP, your PrEP medications will be covered 100% by the OHIP+ Children and Youth Pharmacare Program if you don’t have insurance of your own, or through your parents / school / employer plan.
University of Toronto Students: If you are a student at the University of Toronto, you are automatically covered for PrEP under your Manulife insurance plan. If you need more info, get in touch with us.
Other colleges and universities: Coverage varies for other colleges and universities in Ontario. If you have a 'Pay Direct' card, you call us at The Village Pharmacy and we'll tell you how much coverage you have, and what your out-of-pocket costs will be.
Some insurance plans request that you use a preferred pharmacy chain or mail-order pharmacy to fill your prescriptions. You should know that if you are not happy with the pharmacy stipulated by your employer’s insurance plan, you should request the use of your choice of pharmacy that best serves your needs. Speak to your Manager, or the Human Resources Benefits Manager at your office.
Here’s an interesting news story on how some employees were successful at reinstating patient choice for pharmacies from their employee insurance plans in Canada: http://www.cbc.ca/news/canada/drugs-pharmacies-ppns-1.4250185