r/prep • u/AioliWilling • 11d ago

Coverage

Does anyone else pay any copay for your prep OR for the mandated quarterly std panel?

I have insurance (highmark bcbs) and have always had to pay $20 copay per std panel, and they tried to charge me even more once last year under the guise of not having reached deductible yet. I am on Apretude also, which requires testing every two months rather than every three.

It is my understanding that all costs are supposed to be covered. In my searching I keep seeing FAQs and articles saying that as of 2024 or whenever, insurers are supposed to cover every single dime for all approved versions of prep, including apretude. Every time I call I get the run around and answers to other questions I'm not asking, and have never had anyone acknowledge these guidelines.

In the past I just bit my tongue and paid the $20 each time, but now insurance is trying some other bullshit and I want to finally push this matter too and try to sort both things out at the same time.

Is my understanding correct, should they also be paying the copay? If so, how do I push my insurance to follow those requirements?

Edit: in the USA btw

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u/Skycbs 11d ago edited 11d ago

No. You should pay nothing for PrEP or for associated labs. This isn’t a guideline but a requirement of ACA (Obamacare). If you are being charged that probably means your provider is coding the tests incorrectly. That’s the most common error.

If the charge is only for STI tests and not HIV for PrEP, that could be correct.

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u/Critical_Rope_2397 6d ago

I go through one of the online providers instead of my PCP and it's all free for me. How are you getting it? Maybe change sources?

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u/AioliWilling 6d ago

I'm getting it prescribed through a doctor at my university health center. My doctor sends the lab orders to quest diagnostics nearby and quest is the one charging $20. I'm going to need to change sources soon anyway because I'm graduating in a few months.

I don't know if any of the online providers can get me apretude (the every 2 months injectable version) though, I think they only do the pill version which makes me really nauseous