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Some rather large pharmacies cannot bill the Gilead/McKesson copayment assistance program directly. Nevertheless, you can use the program on a reimbursement basis. Save your receipt and your prescription label, go to http://www.patatientrebateonline.com/ , enter the information from your Gilead/McKesson card, print your customized form, attach the documents, and mail it in.

One more thing: there is no FDA-approved generic version of Truvada, contrary to what foreign online pharmacies claim (see my posting history for a message on that topic). If you rely on a foreign pharmacy, you have no idea what you are getting; it could be a blue placebo, for all you know. It is also illegal to import prescription drugs into the US. You might get lucky, or your shipments might be seized by customs and you might be fined.

Have you investigated New Jersey's Medicaid program, and/or Affordable Care Act exchange? (Aside for low-income readers: at least one state is including Truvada for PrEP in its subsidized HIV drug or Ryan White Act program. I learned this in a chance conversation with a state health official, at an HIV prevention conference two weeks ago.) Because New Jersey is an urban state, Truvada for PrEP is almost certainly covered by the state's Medicaid program and included in the state's model formulary for Affordable Care Act health plans. (You can easily answer both questions online.) Medicaid is the federal-state insurance program for the poor, and though you mention a high income from Gilead's perspective,* most blue states (historic Democratic Party strongholds) have voluntarily expanded eligibility for Medicaid. The threshold is a multiple of (not one time) the federal poverty line. If your income is too high for Medicaid, then you will have no difficulty paying the net (see below) monthly premium for an ACA plan. In fact, you will owe a fine with your 2015 income tax return if you do not have equivalent health coverage throughout the year. A mandate to have or buy insurance is part of the Affordable Care Act. You can use your state's online exchange to compare plan designs and prices. You must weigh the prescription drug, lab test and office visit coinsurance percentages/copayment amounts, and the annual out-of-pocket maximum, against the monthly premium, to find the plan with the lowest total cost. Check the drug formularies carefully, in case Truvada is in a high-priced "specialty tier". Even though you've found a clinic willing to do the initial and periodic testing required for PrEP, and to prescribe Truvada, most insurance plans do not cover items ordered by parties external to the plan. A doctor and a lab who participate in your health plan will have to test and prescribe, if you want the plan to cover PrEP. (It is possible that your clinic participates in one or more ACA plans.) Most ACA participants qualify for a presumptive tax credit, or subsidy, which reduces the monthly premium. Thus, if you earn too much for Medicaid but not enough to comfortably pay for a silver-tier (mid-level) plan, you will get monthly financial help from the federal government. * I read recently that Gilead's income cutoff for payment of the full cost of Truvada is $58,000 per year. I have not verified that figure. To be clear to other readers, there is no income cutoff for the copayment assistance program, under which Gilead provides up to $300/month toward one's out-of-pocket cost for Truvada.

Just to clarify, Kaiser San Francisco has several primary care "modules", so that patients can be assigned to primary care doctors with specific skills. The HIV module as a rule serves only patients who are positive.The team that coordinates PrEP at Kaiser San Francisco is not the HIV primary care physicians' module, but rather, a group of pharmacists with special degrees and qualifications, working under the head of Infectious Diseases. Someone on this team essentially brokers standing laboratory orders, Truvada prescription refills, and patient communication. Most of the interactions happen via secure online messaging or by telephone, with office visits only as necessary. Once again, the HIV care physicians at Kaiser San Francisco treat positive patients, not PrEP patients. The FDA prescribing guidelines for PrEP are easy for any primary care physician to follow. Also, physicians specializing in HIV care have experience with treatment, not prevention -- unless they are researchers. Primary care, perhaps with backup as at Kaiser San Francisco, is an economic and medically appropriate place to house PrEP.

Statistically speaking, such side effects are rare. Since most use of either of the two drugs in Truvada has been in combination with additional drugs, for treatment of HIV in positive patients, it's likely that side effects will be even less frequent when Truvada is used by itself, and by negative patients. The upshot? Please be sure to discuss your symptoms with your doctor, if you haven't already.There are case reports where, for example, doctors saw initial kidney problems, backed off the drug completely, and then had patients resume treatment with no problem. The iPrEx-OLE study of course found 100% protection in patients with blood levels of Truvada consistent with 4-day-a-week dosing, but I heard Dr. Robert Grant himself recommend, just last year, that PrEP patients continue to take Truvada daily.You'll be encouraged by the early results of the IPERGAY trial, which uses episodic dosing: 2 tablets 2 to 24 hours before sex and 1 tablet every 24 hours until 1 day after the last sexual encounter. Please, please rely on your doctor instead of on online advice -- and always disclose missed doses and sustained breaks in Truvada usage. Frequent HIV testing with a 4th-generation antibody test becomes especially important when there is sexual risk and less-than-daily Truvada usage.

A few points...The monograph included with Truvada says that it is to be stored at room temperature. The FDA prescribing guidelines for Truvada for PrEP are based on rigorous clinical trials. There's no conspiracy involved. The medication causes serious kidney and bone problems for a very small fraction of patients, hence the need for quarterly monitoring. As bearbandit explained, the two drugs in Truvada are strong enough to prevent HIV but not -- without a third drug -- to treat HIV, hence the need for initial and quarterly HIV testing. Re: build up, I personally heard Dr. Robert Grant, who has participated in much of the US-based research on PrEP, suggest at least a week. It's certainly not a question of months. The IPERGAY study is currently reporting a high degree of success with episodic dosing: 2 pills 2 to 24 hours before sex, then 1 pill every 24 hours until 1 day after the last sexual contact. Re: prescription rules, there seems to be a misunderstanding here, from countries like the UK and Australia where government pays for drugs. Prescription and payment are separate questions. If your Australian doctor has written you a prescription for Truvada on his or her prescription pad, then you do have an "off-label" prescription. There is nothing forbidding this in most countries. You can bring such a prescription to your usual pharmacy and have it filled locally, just as if you were an HIV-positive patient using Truvada. The issue is who will pay, given that you wish to use the drug for a purpose other than HIV treatment, the purpose for which it is approved (labeled) in Australia. It does look as if personal prescription importation is legal in Australia, unlike in the US, though the usual cautions about online pharmacies apply. http://hivfoundation.org.au/sites/default/files/PrEP%20Access%20Fact%20Sheet%20Feb%202015_0.pdf

Hi, bearbandit! I'm sorry to hear about the PrEP situation in the UK. So there's an explicit bar to this off-label use of Truvada? How silly! Let's hope that PROUD and IPERGAY will convince the authorities to grant full approval in a few years' time. Still, I'm worried that there is a foolish emphasis on minimizing short-term cost. For example, I read of an NHS policy change that forced HIV patients to abandon the newer, brand-name, once-a-day extended-release formulation of Viramune for the older, twice-a-day formulation, by now a cheap generic. Canada is different in that the provincial government health plans do not pay for prescription drugs. Off-label use has no short-term negative effect on government finances. (Only seniors and the poor receive a drug benefit, cf. Medicare and Medicaid in the US, and there is a program to pay for HIV treatment drugs, cf. Ryan White in the US. Funny how a country can be progressive as to covering medical services, but adopt US-style practices for prescriptions.) I'm eager to hear about the situation in other countries, such as Australia... I applaud you for supporting drug recycling. I met an amazing man years ago in San Francisco who was a humanist and led a drug recycling effort here. It seems safer to depend on local or even foreign donated drugs than on offshore pharmacies, as there is no financial motive in the former case.

This supplier is highly suspect, because they advertise "free shipping to United States" and claim to "only supply non-restricted medicines that we source from FDA approved manufacturers." Not only would receiving such a shipment be illegal in the US, but there is no FDA-approved generic for Truvada, as Gilead's US patent is unexpired. Gilead does license some of its drugs in Third World countries, but this supplier's claims are false.

You should absolutely follow the United States Food and Drug Administration testing protocol, described by barebandit. As for getting the medication, most countries give physicians the discretion to prescribe already-approved drugs (Truvada is approved for HIV treatment in most countries) for "off-label" uses. This is how Canadian patients are accessing PrEP, for example. Whether the cost of an "off-label" prescription would be covered by a given public or private insurance plan is another matter. Receiving personal shipments of prescription drugs from foreign countries is illegal in most jurisdictions. It is also risky. If counterfeit drugs have appeared in the pharmacy supply chain in developed countries like the United States, can you imagine what happens in India, Mexico, etc.?

You could reference the latest empirical studies, such as iPrEx-OLE and IPERGAY, and discuss your PrEP adherence, but this would be useless because sex is, for most people, as far removed from the realm of rational decision-making as possible. You could explain vaccinations for Hepatitis A and B and HPV, routine testing and antibiotic treatment for chlamydia, gonorrhea and syphilis, testing and now a medical cure for Hepatitis C, and so on -- as much to disclose what you do as to educate them -- but this too would be a waste of time if they have shame or fear. Or, you could just pre-lube your hole with your favorite oil-based lubricant. ;-)

It is probably not legal for an ACA-compliant health plan to categorically refuse to cover Truvada for PrEP. In California, this would also be contrary to state law. Of course, to cover does not mean to cover affordably. Plan features such as high annual deductibles, percentage coinsurance at any level, or high fixed-dollar copayments, mean that patient cost varies based on the quality of the plan. Each year, plans can increase all of these amounts. Even high-quality plans can manipulate patient cost. For example, though Truvada for PrEP is on the prototype formulary for ACA plans in California, some insurers have placed it in a "specialty" tier with a higher copayment. Other plans have restricted access by, for example, limiting the allowed supply of Truvada for PrEP to 30 days and requiring the prescription to be filled at one specific pharmacy. Some plans and providers also make separate, full charges for multiple blood tests performed together, even though the phlebotomy work -- a major part of the cost -- is not repeated. Finally, when a plan involves standalone doctors' offices and laboratories, most of these do not support internal or external electronic communication, which means a doctor's office visit fee every quarter to get a laboratory requisition, and another office visit fee to get results. On the question of cost to insurers, if PrEP is given to patients at a truly high risk of getting HIV, and if efforts are made to motivate adherence, it will be cheaper than treatment in the long run. All bets are off if the mandate to carry health insurance is dropped, or the requirement to provide coverage without regard to a person's health is dropped, or some other factor results in "dumping" HIV-positive patients back into public plans such as Medicaid/Medi-Cal. On the insurer cost side, a very positive factor is that the patent on Truvada will expire soon, allowing generic drug manufacturers to step in.

Congrats! Think of all the sperm you've had inside you and all of the men who have enjoyed thar beautiful ass. You are making the world a happier place.

It would look awesome!

Well said. HIV isn't a barrier to love and intimacy, especially today with TASP and PrEP. Though sex isn't everything, its absence often does spell the death of a relationship.

I agree. I'm a mixed black/white top and I think people are over-analyzing things. Fuck and get fucked by whomever turns you on!Whether it's a big dick, a small dick, an uncut dick, a contrast in skin colors, different mannerisms, a taboo, a fear, a preference, or even a prejudice, just fuck, already! If there is prejudice at work, I prefer that it be acknowledged openly, so that both partners can decide whether they are comfortable, and if they are, proceed to fully enjoy the sex. I would not be offended in the least if a "faggot white boy" told me he wanted to "sit on my BBC" and "take my n----- sperm", nor if a "white master" wanted to role play forcing me to blow him out back on the plantation. (Entire doctoral theses have been written in the US and Europe about sexual relations under colonialism and slavery, and the picture is quite nuanced.) In fact, I did a role-play with a Japanese guy a few years ago, with him in the dominant role. Aside from the fact that he was out-of-my-league hot, we specifically looked forward breaking what we acknowledged to be stupid, externally-imposed American and Gay social rules. There are almost no Asian/Black Gay porn films, and Asians are falsely assumed to be submissive and to have small dicks. Straight porn is littered with films involving burly Black men fucking petite Asian women. None of this nonsense has anything to do with whether two real people can connect and have a hot fuck.

This is a bit like the recurring rhetorical questions in the Jehovah's Witness magazines: "Should there be rule by the clergy?" "Can there be heaven on earth?" etc. The only answer is yes. Incidentally, if you are looking for a relationship and you want frequent sex to be a part of it, getting bred on the first date is a great way to start.

I fucked around with a clerk from the 16th and Bryant post office in San Francisco, when I lived in that neighborhood. He was very passionate; I remember long drives and lots of kissing. He was irrationally afraid of HIV, which meant no fucking, even with a condom. (Of course, I wanted to coax him into taking my dick, and eventually, my load.) He gave great head, and I vividly remember pushing him down onto my dick. He was Filipino, lived with family, and was not out, so there was no prospect of a relationship. This, and the impossibility of fucking, drove us apart. (Kissing and fucking -- especially bare -- make me feel close to a guy, and head -- preferably with each of us swallowing -- is also necessary for fun. We had two of the three, but I couldn't imagine not being allowed to fuck my boyfriend.) In the end, I stopped going to that post office to prevent any possible awkwardness. Though we were involved just a month or two and this was 15 years ago, I still think of him whenever I'm in the neighborhood. I hope by now that he's out, sexually free, and with another guy who cares about him.

On the contrary, I'd say it was very successful: you're back in the game, getting your needs met!

No, it is part of the current U.S. Centers for Disease Control (CDC) PEP guidelines. It is an attempt to avoid prescribing a drug to which the person's virus is already resistant.

You shouldn't give up the sauna if you enjoy it and if he's free to fuck other men. The odd trip to the sauna wouldn't hurt anyone!

You obviously enjoy cheating, you've been responsible by getting on PrEP to protect yourself and your BF from HIV, and your BF can't countenance an open relationship, so there really isn't much of a choice. Have fun, keep it discreet, and get tested for STDs regularly!I went through phases of my domestic partnership/same-sex marriage when I didn't cheat, but this had more to do with lack of opportunity or lack of time than with an intention to stop cheating. He never found out, and I never told until the very end, when it didn't matter amymore. Now I'm with a wonderul man who is as much a slut as I am. We have a great sex life at home and we're open to playing together as well as apart. We realize that our connection has to do with more than our dicks. Don't be hard on yourself. You're satisfying a basic human sexual need, you're protecting your BF from the main health risk, and you're protecting him emotionally by keeping it secret. There is nothing "dirty" about sex with multiple partners. Someday your boyfriend will learn that, when a forbidden cock is about to spurt in his mouth or he is about to breed a stranger's ass. At that point you can talk about opening up the relationship. As others have said, there is never any reason to confess past exploits to him; just couch it in terms of future desires.

Just a note, knowing that bearbandit is in the EU and not knowing where curiousone is:In the United States, Truvada for PrEP passed clinical trials (proving safety and efficacy) several years ago and gained Food and Drug Administration (FDA) approval in 2012. Here it is no longer an experimental drug, and this is why it can be covered by insurance plans, all of which have blanket exclusions for experimental treatments. Next time I open a bottle I will look at the patient prescribing monograph (unfolds to newspaper-size sheet), but I don't recall reading or being given any official advice about weeks-to-effectiveness from San Francisco Department of Public Health/UCSF (major PrEP research center) or Kaiser Permanente (my private healthcare provider). After proving to yourself that you are using the medication on a reliable daily basis, go out and have fun!

I have a grandfathered (pre-Obamacare) individual plan from Kaiser. My copayment for a 90-day supply of Truvada is $35. This, in turn, is reimbursed by Gilead. My copayment for as many tests as I need in one session is $10. (The FDA prescribing guidelines for Truvada for PrEP call for various tests to be done at least quarterly.) The same insurer will offer so many different plan designs through so many different channels that it is impossible to say which insurer is best. Some plan designs have no prescription coverage at all. Some have high annual deductibles. Some have high copayments for prescriptions and tests. Some cover only 30 days' worth of medication with each drug copayment and only a single test with each laboratory copayment. Some require pre-approval for expensive services. And so on... An equally important consideration is who will be providing your medical care. What primary care doctors, infectious disease specialists (if the primary care doctors are backward and unwilling to oversee PrEP care; N.B.: HIV and ID specialists have no experience or particular training for providing preventive care to HIV-negative patients), laboratories and pharmacists are affiliated with the plan? Good providers are aware of current drug approvals, protocols, and research -- crucial in the case of PrEP. They have online systems that make it easy for you to get tests, access test results, and communicate periodically with your doctor. Billing and payment are convenient and accurate, with no buck-passing between insurer, primary care doctor, specialty doctor, and pharmacy. In this respect, Kaiser is ideal. Insurer and provider are one in the same. Any Kaiser primary care doctor need only log in to the computer system to read a standard protocol for PrEP intake and ongoing care. Standing laboratory orders are stored online and you can get your tests done at any Kaiser facility in your region. Test results are available online, often the same day. Instead of wasting time and money on routine office visits, you can communicate with the provider who oversees your PrEP care by secure e-mail. Coverage for PrEP is addressed during the intake process, and there is only one party to pay. The only drawback is that Kaiser pharmacies, unlike CVS, Walgreens and other commercial operations, cannot accept Gilead/McKesson copayment assistance cards. Instead, you must print out a reimbursement form, fill it out, attach your prescription receipt and label, mail everything in, and wait for a check to be mailed back to you. The fact that your doctor can use an online system to have your Truvada prescription ready for you in the time it takes you to get from his or her office to the pharmacy downstairs, more than makes up for this.

This is the best!

This is so funny and so true! I love breeding guys who are in fairytale gay marriages. The best part is being invited over when hubby is out, and fucking on the same bed. Gay married men who cheat tend to feel guilty, which makes for long gaps in contact. Eventually, though, sexual need always wins out over guilt. I wish that these men -- and their husbands -- could understand that love has nothing to do with where you put your dick.