Kaiser PrEP: Protocol and cost details.

[rawfuckr]

I get this asked often so I'm going to write it down here for those interested. This is for Kaiser in California, specially in San Francisco where I am.

The Protocol

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Kaiser is a solid choice for PrEP. They have a 'protocol' setup for administering PrEP and they are sort of strict about it.

1) You first go to your PCP, although you can probably try to just message them through the online system. He/She'll refer you to the HIV specialists.

2) With the HIV specialist you'll have an 'assesment visit' where they'll determine if you are a good candidate for PrEP. I'm sure that most people here will, but essentially if you say you are getting fucked bare you are in.

3) Before the first prescription is issued you'll have to do comprehensive testing that includes: creatinine clearance, gonhorrea and chlamydia(RNA tests), syphilis, HIV(PCR first test, regular antibody after), HepC(just first test), phosphorus, urinalysis, ALT liver levels(just once). If HIV is clear you'll be issued a one 1 month prescription with 2 refills.

4) For the first three months they want you to go back every month and get tested for HIV and STDs. They will monitor this and if you don't go back to get tested it may raise questions about your adherence to the program. The first three months you get tested every month, and then the frequency goes down to once every three months. At that moment they only require you to get tested every 3 months but you can do more often if you wish.

I'm assuming they do all to assess the patients commitment to PrEP. Given that Truvada is so expensive they probably don't want to give it out like candy. It may sound like a lot of hoopla but they make it easy and painless. Even once a month testing is just not a big deal, and if you have any questions they are just online message away.

The costs

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These are examples using prices from individual ACA plans of 2014 California. Silver and Platinum level prices are quoted.

In terms of costs you have to be aware that its not just the cost of Truvada, you'll have to pay copays for the following in a year:

- Initial PCP visit for referral ($45 silver, $20 platinum) (maybe free if you get referral asking through online portal)

- Initial visit with HIV doctor ($65 silver, $40 platinum)

- First three months of testing lab copay($45 x 3 silver, $20 x 3 platinum)

- Recurrent three month testing lab copay ($45 x 3 silver, $20 x 3 platinum)

- Truvada RX ( $50 x 11 silver + $250, $15 x 12 platinum )

TOTAL: $380 + $800(RX) silver, $180 + $180(RX) platinum

Given that the RX component can be mostly reimbursed by Gilead usually the silver plan is the 'perfect' plan for PrEP here in california. Depends of course on other health factors you may have. Silver has about a 25% cheaper premium so you have to do number crunching there.

If you have questions let me know.