Some, but by no means all, insurance companies in BC cover PrEP. Because PrEP is such a new medication in Canada, even if you have insurance that covers it, you might need to take a few extra steps first before you can get the prescription covered. Your insurance provider might ask you for some additional information from your doctor or nurse practitioner, or for what’s called a ‘drug exception request,’ or even documentation from the BC Centre for Excellence in HIV & AIDS stating that you aren’t a poz guy. When insurance companies ask for these things, it’s usually because HIV medications in BC aren’t ever covered by private insurance- they’re paid for by a special program set up by the province. Sometimes an insurance company will see a prescription for Truvada, and refuse it because they think you might be eligible to get the prescription through the province. When this happens, you usually just need to take a few more steps before you can get your prescription filled. It can take a while (even up to a month) to work through the steps with your insurance, so it might be helpful to start working with your insurance as your first step after you get your prescription, and do all of your tests last. If you do your tests first, and then have to spend a few weeks waiting for coverage, you might have to do some or all of the tests all over again. If you have questions or need assistance in working with your insurance provider to access PrEP, call HIM at 604-488-1001, and we can help connect you with a Health Promotion Case Manager who can help you navigate the process.
Other Ways to Get PrEP
There may be research studies in Vancouver (or other major cities across Canada) that will provide PrEP for participants. In these studies, sometimes all the participants will receive the drug, and sometimes only half will (like when they’re comparing guys not taking PrEP to those who are). Right now there aren’t any active PrEP studies in Vancouver, but this could change- make sure and sign up for our email list and check our NEWS page regularly for updates, including active recruitment for local or national PrEP studies.
If you live in Vancouver, you might have heard guys talking about ‘generic PrEP’ or ‘generic importation.’ In a nutshell, some countries have received permission from the World Health Organization (WHO) to manufacture generic HIV and HIV prevention medications even though these medications are still under patent in Canada (this means we can’t manufacture a generic here yet, though that may change in 2017). These manufacturers supply a lot of different kinds of generic medications, and their manufacturing sites and practices have been reviewed and recognized by the United States Food and Drug Administration (FDA) and WHO as reputable suppliers of medications, including emtricitabine / tenofivir (the combination of meds used in Truvada, and also generic PrEP). Because Truvada is still under patent in North America, it’s still a very expensive medication in Canada- so expensive that most guys without insurance simply can’t afford it. Because Truvada for PrEP isn’t listed through Pharmacare (and might never be), and because a lot of guys don’t have private insurance or have insurance plans that won’t cover PrEP, generic importation is one way that PrEP can be made more affordable for guys without any other access.
In Canada, both Health Canada and Canada Border Services Agency (CBSA) allow Canadians to import up to three months of a prescription medication in order to continue a course of treatment, so long as it’s brought into the country on your person (this means it can’t be mailed in), and you have a copy of your prescription, and don’t bring more than a three-month supply in at a time. IF YOU ARE IN CANADA ON A TEMPORARY PERMIT (not a permanent resident or citizen; for example, if you're here studying),YOU MAY IMPORT A 90-DAY SUPPLY OF GENERIC PrEP BY MAIL. Please note, however, that all other rules and regulations that apply to importation by permanent residents and citizens still apply. For some guys without access to insurance, or who can’t afford to pay out of pocket, importation is the only way for them to access PrEP (for more specifics on generic importation, you can go HERE). HIM neither endorses nor discourages importation of generic emtricitabine / tenofivir (aka generic PrEP), because we recognize that for most guys in Vancouver, importation is their only option, and we recognize that some guys who are at high-risk for HIV with no other access to PrEP may decide that importation of generic PrEP is right for them. For a link to CBSA regulations on importing generic drugs, please visit their site and scroll to the section titled "Personal Importation of Generic Drugs" HERE.
For guys who are importing PrEP, we remind you that just like any PrEP prescription, you need to take this medication under the supervision of a licensed medical provider, and need to make sure that you are following the once-daily PrEP dosing, and quarterly testing for HIV, STIs, and kidney function as recommended by Health Canada. We know that some guys might have concerns about the quality of generic drugs. In the United Kingdom, 56 Dean Street (one of the world’s largest gay men’s health clinics) has been conducting free blood drug level monitoring for generic PrEP users. This means that they take a blood sample once a month to ensure that the level of PrEP in the blood is sufficient to prevent HIV transmission, and that the generic they are taking has the same concentrations of medicine as Truvada for PrEP. To date, they have found no discrepancies between generic PrEP and Truvada for PrEP. We also know that some private clinics here in Vancouver are also offering blood drug level monitoring for their patients, but this service isn’t widely available in Vancouver yet.
HIM supports the use of imported PrEP for HIV prevention when other methods aren't feasible, accessible, or effective for guys, AND if the person decides for themselves to take the risk of using products that aren't regulated by Health Canada, even though they are legal for you to bring into Canada.
We don't see the supply chain guys are using to get generic PrEP, so we can't say anything about the PrEP guys are getting through generic importation. Because of the work of 56 Dean Street in the UK, and some private clinics here in Vancouver, we do know these medications are being monitored for safety and effectiveness, and that no issues have arisen yet. We just want to be clear that HIM is just not in a position to confirm that what guys are getting through generic PrEP importation is the same stuff as Truvada- that's up to the guys who take it to decide. We do know some clinics are doing blood drug level monitoring here in Vancouver, so if you’re taking generic PrEP, you may want to talk to your health care provider to see if that’s an option for you.
We recognize that the importation of generic medications is approved by Health Canada and the CBSA, and want to remind ANY PrEP user that these medications must be taken under a doctor’s care regardless of where they are sourced. Whether you get your prescription at a Canadian pharmacy or via generic importation, after you start PrEP, always remember that you’ll still need to get the mandatory up-front HIV, kidney function, and Hep B tests, and will still need to be tested every three months for HIV, STIs, and kidney function. These are all quick and easy tests, and only require your provider to take some blood samples and send into a laboratory for analysis.