Matthew Hurley faced a frustrating journey when trying to access PrEP, a medication designed to prevent HIV. Initially, his doctor didn’t even recognize what PrEP was, leading to confusing and costly billing issues. Hurley expressed his frustration, stating, “Am I just going to stop this medication to avoid these scary bills?”
Hurley’s scare began with a text asking, “When was the last time you were tested for STDs?” after he had unprotected sex with someone who tested positive for HIV. Fortunately, his test came back negative, but it was a wake-up call that pushed him to seek out PrEP, which can reduce the risk of contracting HIV by 99% when taken as prescribed.
After starting PrEP, Hurley’s experience took a turn for the worse when his insurance changed. His new doctor had never heard of PrEP. “I found myself teaching him about it,” he recalled.
Despite living in the San Francisco Bay Area—a region known for its LGBTQ+ activism—Hurley was left to advocate for himself in the exam room. Beth Oller, a family medicine physician, noted that many LGBTQ+ individuals frequently face negative experiences in healthcare settings. “They feel like they have to educate their providers, which can be exhausting,” she said.
Not only was the lack of awareness alarming, but billing complications soon followed. Hurley received several incorrect bills totaling hundreds of dollars despite knowing that PrEP-related services should be covered under the Affordable Care Act. Each time he appealed these charges, he felt overwhelmed by the process. “I estimated I spent over 60 hours contesting such bills,” he mentioned.
Eventually, Hurley switched to the AIDS Healthcare Foundation, where the staff understood PrEP and were well-lit on billing codes. “I haven’t received a surprise bill since,” he said. Yet he emphasized that separating sexual health care from primary care still presented challenges.
The Centers for Disease Control and Prevention (CDC) encourages all primary care providers to consider prescribing PrEP as a preventive measure. Unfortunately, this isn’t always the reality. A 2022 survey showed that approximately 22% of people in the U.S. who could benefit from PrEP have been prescribed it, highlighting a significant gap in awareness and access.
Here are a few tips to help navigate the complexities of accessing PrEP:
- Know Your Options: The CDC estimates that 2.2 million Americans could benefit from PrEP, yet many remain unaware. It’s crucial to assess whether you fit the criteria for this medication.
- Educate Your Provider: If your doctor seems uninformed, don’t hesitate to share resources and ask questions. The CDC and other organizations provide guidelines that can be helpful in these discussions.
- Lab Work Matters: Ensure your lab work is coded correctly, as mistakes often lead to unexpected costs. Seek services in-network when possible to avoid additional complications.
- Look for Savings: Generic versions of PrEP can provide cost-effective alternatives. Be sure to check your insurance plan or consider manufacturer assistance programs if you’re uninsured.
- Explore Telehealth: If you struggle to find an affirming provider nearby, telehealth options are becoming viable and allow for more privacy and comfort in discussing sexual health.
- Seek Affirming Care: Use resources like the LGBTQ+ Healthcare Directory to find affirming healthcare providers in your area who can offer the support you need.
As sexual health continues to evolve, it’s clear that greater awareness and education are essential. Individuals like Hurley highlight the importance of being proactive and informed, paving the way for others in similar situations.
