Starting the process

[drscorpio]

Saw the doctor this afternoon. Assuming all my bloodwork looks good, I should be on PrEP next week.

[drscorpio]

All the bloodwork was fine except my Hep B antibodies aren't good enough from getting vaccinated in the 80s. So I have another month before the ID doc will write the prescription (after the second Hep B vaccine shot).

[drscorpio]

My doctor wrote the scrip for PrEP today.

[tallbtm]

Great. That certainly took long enough! 

Hope you're like most guys who have no side effects at all. 

[drscorpio]

Thanks.

The delay is largely caused by having to go through an ID doctor who is an hour away and who only sees patients one day a week which unfortunately given my teaching schedule this spring was the worst day for my schedule.

[backpackguy]

Hey buddy, glad u finally got your PrEP - what an ordeal. Today is my 1st anniversary on PrEP...no side effects. gives me peace of mind when I release the inner pig to play!! Oink, oink    

[drscorpio]

Well, there was another weird snafu where my prescription didn't get processed, but the wait is over. After slightly more than one year, I just took my first dose. 

[fskn]

Not sure I agree. There is plenty of medical protocol that needs to be observed with PrEP and seems reasonable at this moment to bump people to ID docs. Sure, maybe the GP is a bit lazy to research stuff and do it on their own but I'm sure in a year or two they'll get up with the program and do it themselves.

I'm getting PrEP with Kaiser and they have a whole team of docs here in SF doing PrEP alongside with HIV care and that's the way they want it, and this is from the quintessential HMO who is always looking at keeping costs down.

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.

Edited May 30, 2015 by fskn

[str8butilikeit]

didnt read all the comments but did a quick scan and wanted to put my 8 inches into the discussion. personally i think that it should be standard protocol to do PrEP through an infecious disease specialist as they are actually focusing on issues like HIV and already understand the whole thing. a GP is just that A GENERAL PRACTITIONER who handles OVERALL health care and is expected to deal with the usual issues ANY person walking into their office might normally have. you dont expect him to handle cancer issues so why would you DEMAND that he handle HIV related issues? i do think that GPs should become aware of what is needed for the usual course of events during PrEP so you can do whatever NORMAL followup and checkups through your GP as to the best of my knowledge it is basically "are you having any of this list of side effects or any other issues?" and if blood work is needed any phlebotomist can draw blood and ship it to a ID spec or regular lab for analysis, and you would go back to the ID spec if there is any cause for a more knowledgeable analysis

[NastyPigBear]

Not sure I agree. There is plenty of medical protocol that needs to be observed with PrEP and seems reasonable at this moment to bump people to ID docs. Sure, maybe the GP is a bit lazy to research stuff and do it on their own but I'm sure in a year or two they'll get up with the program and do it themselves.

I'm getting PrEP with Kaiser and they have a whole team of docs here in SF doing PrEP alongside with HIV care and that's the way they want it, and this is from the quintessential HMO who is always looking at keeping costs down.

 

The CDC protocols are well documented, easy to follow, and written with the specific intent of enabling any primary care physician to prescribe and manage PrEP. It literally takes about five minutes of reading to be up on it.

[j75206]

Fortunately I chose a gay DR that was already a ID specialist so it was about the easiest thing I have ever done..

[drscorpio]

The fact that my doctor wanted to refer me to an ID specialist was annoying since the doctor was an hour away. I was willing to deal with that because he told me he thought the other doctor could give me better care. The fact that he did not follow up to make sure that happened was what I found unprofessional.

[LarsLukas]

My experience has kinda been the same. My primary who is very consertive on prescriptions, referred me to ID. Brought info to both.... ID guy said I was the first person that came to him wanting to be on PrEP... and said he didnt know much about it. But did say he was going to read up on it. He ordered bloodwork, and set another appt.  Bloodwork came back fine and he agreed to write the script for Truvada. Blue Cross Blue Shield covers the cost, blood work was like 1500. my 90 day supply thru mail order is 70. for 3 month supply. I also have the Gilead card but the mail order company said they do not honor because they have discounted.... Im like that has nothing to due with discount, it has to due to pay my copays.... they were like take it or leave it.  I didnt look into taking script to like a walmart but isnt worth the bs to save 70.  I wanna be sucking and getting fucked by cock not chasing possible drug savings

[wickedwet]

One area i don't see discussed much is side effects to Truvada when using OTC supplements. My I.D. Dr. at South San Francisco Kaiser dropped me from Truvada as I had high creatine level. She never asked me about the impact this would have on me. It wasn't until I STOPPED ALL supplements (including ibuprofen) for a surgical procedure and subsequent kidney test that my levels returned to normal (still taking Truvada at the time!). I'm now "challenging" the previous results in hope she'll get on my side of this topic and work with me to prescribe the drug. To her credit, however, she passed along a study (http://www.cdc.gov/nchhstp/newsroom/2015/IPERGAY-2015-Media-Statement.html) where "..findings combined with other recent research suggests that even with less than perfect daily adherence, PrEP may still offer substantial protection if taken consistently". The take home for me is our Dr's need education about outlying factors of side effects and we need to educate THEM on what it means to be in our position.

[fskn]

...my 90 day supply thru mail order is 70. for 3 month supply. I also have the Gilead card but the mail order company said they do not honor because they have discounted.... Im like that has nothing to due with discount, it has to due to pay my copays.... they were like take it or leave it. I didnt look into taking script to like a walmart but isnt worth the bs to save 70. I wanna be sucking and getting fucked by cock not chasing possible drug savings

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.

Edited June 26, 2015 by fskn