Truvada is the brand name of a prescription medication used to treat and prevent HIV. These types of medications are known as antiretroviral drugs.
All Medicare Part C (Medicare Advantage) and Part D (prescription drug) plans are required to cover antiretrovirals like Truvada.
However, many plans have high levels of cost sharing for this drug. In fact, researchers estimate that less than 10 percent of people who could be helped by Truvada are taking the medication, in part because of its high cost.
The amount youâ€™ll pay for Truvada depends on your plan, how the drug is classified within the planâ€™s tier system, and your eligibility for any programs that help could lower costs.
Itâ€™s important to consider plan costs carefully when choosing a prescription drug plan to purchase. A 2017 study showed that Medicare beneficiaries living with HIV often pay higher premiums for plans with low deductibles, and the savings donâ€™t always add up.
Letâ€™s take a closer look at what different Medicare plans will cover if youâ€™re prescribed Truvada.
Does Medicare cover Truvada?
Medicare Part D plans are prescription drug plans, and theyâ€™re required to cover antiretrovirals like Truvada.
But because Part D plans are offered by private insurance companies, each planâ€™s costs and coverage guidelines can differ.
A 2020 analysis looked at how much of the cost Medicare beneficiaries typically paid for Truvada. Researchers found that Medicare paid between 50 percent and 76 percent of the medicationâ€™s cost overall.
Your costs will depend on several factors, including:
- whether you have met your prescription drug deductible for the year
- what your planâ€™s cost sharing requirements are
- how your plan ranks Truvada on its tier system
- whether youâ€™re eligible for any special programs that help with your costs
Many plans rank Truvada as a tier 5 (specialty) medication. Tier 5 prescription drugs cost more than those in tiers 1 to 4.
To find out how your plan classifies Truvada, you can check your planâ€™s formulary. This is the list of prescription drugs your plan covers.
If youâ€™re considering a change to your Medicare Part D plan, you can use Medicareâ€™s plan comparison tool to check the coverage for any medication you use.
What about Medicare Part C coverage?
Medicare Part C (Medicare Advantage) plans are also offered by private insurance companies. They provide the same benefits as original Medicare (Part A and Part B) but usually include other benefits such as vision and dental care.
You can buy Medicare Advantage plans with or without prescription drug coverage. If the plan you choose doesnâ€™t include prescription drug benefits, you can switch to a plan that does. You can make this change during one of the enrollment periods throughout the year.
If youâ€™re using Truvada to treat HIV, you may qualify for a Special Needs Plan. These are a type of Medicare Advantage plan that offers extra benefits to people with certain complex conditions, such as diabetes, heart disease, or HIV.
To find the cost of Truvada with your Medicare Advantage plan, your first step is to look up the medication on your planâ€™s formulary. The formulary will tell you what tier Truvada is in and will explain any limitations or guidelines that affect your prescription.
Youâ€™ll also need to know what your planâ€™s prescription drug deductible is, because the cost of the drug may change once youâ€™ve met your deductible.
Can a Medigap plan help with my costs?
Medigap plans, also known as Medicare supplement insurance, help you pay the coinsurance, deductibles, and copays for your healthcare.
Like Medicare Part C and Part D plans, theyâ€™re offered by private insurance companies. So, specific benefits differ from plan to plan.
Some Medigap plans sold before 2006 included prescription drug coverage. Medigap plans sold after 2006, however, donâ€™t include this coverage. This means the newer plans wonâ€™t cover your costs for Truvada.
How much does Truvada cost?
Exactly how much you pay for Truvada depends on your Medicare Advantage or Part D plan. GoodRx lists the following estimated price ranges for this medication:
- If you havenâ€™t yet met your drug deductible, your copay may be between $54 and $68 for a 30-day supply.
- Once youâ€™ve met the drug deductible, your copay is typically between $13 and $68 for a 30-day supply.
- The average price of a 30- day supply without Medicare, discounts, or other insurance coverage is around $2,208.
If you need assistance paying for this prescription drug, check the companyâ€™s website for more information on how to apply.
What is Truvada?
Truvada is a pill that contains a combination of two antiretroviral drugs: Emtriva (emtricitabine) and Viread (tenofovir disoproxil fumarate).
How is it used to treat HIV?
Truvada isnâ€™t a cure for HIV. Instead, it suppresses the presence of the virus in your body over time. It does this by blocking an enzyme that the virus uses to make copies of itself. Truvada can sharply decrease the amount of HIV in your body because the virus canâ€™t replicate.
Once the amount of HIV in your blood drops below a certain level (200 units per mL), tests can no longer detect it. At that point, the virus is considered to be suppressed.
Research has shown that once the virus is undetectable, thereâ€™s almost zero risk of transmitting it to someone else through sex.
How is it used to prevent HIV transmission?
People who donâ€™t have HIV can take Truvada to reduce the risk of getting HIV through sex or the use of injected drugs. Truvada can be used as part of a pre- exposure prophylaxis program (PrEP).
When people who donâ€™t have HIV take the medication daily, their risk of getting HIV through sex is lowered by 99 percent, and the risk of getting HIV through injection drug use drops by 74 percent.
Truvada works best when taken every day, because you need enough medication in your body to stop the virus.
Though Truvada drastically reduces the presence of HIV in the body, the Centers for Disease Control and Prevention (CDC) still recommends the use of a barrier method, such as a condom, during sex. This will further protect you against other sexually transmitted infections like gonorrhea and chlamydia.
What should I expect when taking Truvada?
You may have side effects while taking Truvada, some of which are mild and others that are serious.
Some of the most common side effects include:
- headaches rash
- stomach pain
- nasal congestion
- trouble sleeping
These symptoms often go away on their own after a while, but itâ€™s a good idea to talk with your healthcare provider if youâ€™re concerned about them. Itâ€™s also very important to talk with your doctor if you experience flu-like symptoms after taking Truvada because they might indicate exposure to HIV.
The CDC recommends that those on PrEP take an HIV test every 3 months. Your healthcare team may also test your kidney and liver function from time to time to make sure the medication isnâ€™t affecting those organs.
Truvada can also cause serious side effects.
One is a buildup of lactic acid in your body, called lactic acidosis. Lactic acidosis can be life threatening. Truvada can also cause serious liver problems.
If you experience any of the following symptoms after you take Truvada, talk with your healthcare provider right away:
- fatigue or weakness
- muscle pain
- shortness of breath
- stomach pain combined with nausea and vomiting
- cold or blue hands and feet
- fast heartbeat
- yellow skin or eyes
- dark urine
- pale bowel movements
- loss of appetite for longer than a few days
Truvada is a prescription drug used to treat and prevent HIV. All Medicare Advantage and Medicare Part D prescription plans cover Truvada, but deductibles, copays, and coinsurance vary from plan to plan.
Compared to many other medications, the cost of Truvada can be high. This high cost may even be keeping people with HIV from receiving treatment or using it as part of a PrEP regimen.
To make sure a plan youâ€™re considering has sufficient coverage for Truvada, you can check the planâ€™s formulary (list of covered prescription drugs) or talk with your insurance provider.
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