Using PrEP

How do I take PrEP correctly?

When you are on PrEP, you will want to take your pill around the same time every day. To make that easy for you, you can use tools like a daily text message reminder. Some people who use PrEP find it useful to take their pill at the same time as one of their daily routines, like right before bed or with lunch. PrEP can be taken with or without food.

Life is busy and people occasionally forget to take their PrEP pill. That’s understandable. If you realize you forgot to take your pill, you can take it later that same day. If you don’t remember until the next day, don’t double your dose; just take one pill as you normally do. Don’t give up!

If you aren’t able to take PrEP as prescribed, it’s less effective at protecting you. So, if you find that you are missing doses routinely or you miss multiple doses in a row, talk to your provider. Another form of prevention may be better for you.


What if I experience side effects?

PrEP is a safe drug and most patients don’t have side effects. Those who do mainly have mild side effects – such as nausea and headache – that often pass after the first month. If they don’t, talk to your provider.

Other more serious side effects – such as kidney and bone problems – can occur. That is why it’s important to see your provider every three months to be checked for any signs of these problems.

For more info on how to manage side effects associated with PrEP, please read the User’s Guide to PrEP.


Once I start PrEP, do I have to keep taking it forever?

Your risks and your need for PrEP can change over time. You can choose to go on and off PrEP throughout your lifetime depending on your needs. However, if you are thinking about stopping PrEP, it’s a good idea to talk to your health care provider first. If you do decide to stop PrEP, remember to use other forms of prevention, such as condoms.

If you decide you want to start PrEP again later, you will need to see a healthcare provider and complete the same screening you did when you first started PrEP.


What if I become HIV positive while on PrEP?

PrEP is highly effective at preventing HIV when taken every day. Typically, people who have been diagnosed with HIV while taking PrEP were exposed to HIV before starting PrEP or were not taking it every day

If you become HIV positive while on PrEP, it’s very important to talk to your provider right away. It’s not good for your health to keep taking PrEP if you have HIV because the virus in your body can become resistant to the drugs used for PrEP.


How much does PrEP cost? Is PrEP covered by drug plans?

In Ontario, PrEP costs about $250 a month, but there are private and public drug plans that will help pay for PrEP. Checkthe list of options below to see if any apply to you.

In Canada, the only medication approved for use as PrEP is a combination pill of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). Truvada is the brand name version of TDF/FTC. There are also several generic versions of TDF/FTC, which are as safe and effective as Truvada and less expensive.

Assistance with PrEP Costs:

You may already have coverage for PrEP through work benefits, a family member’s coverage or private insurance you pay for yourself.

If you already have private drug coverage through your work, through a family member or because you pay for it yourself, your plan likely covers at least some of the cost of PrEP. The amount of money you pay for a prescription and the amount your insurance company pays depends on your insurance plan.

If you want to know whether your plan covers PrEP and how much it will cost you to fill your prescription, talk to a pharmacist. The pharmacist will need to see the card from your insurance provider and will also need the drug identification number to see if the medication is covered in your plan.

Here are various brands of PrEP with their corresponding drug identification number:

  • Teva-Emtricitabine/Tenofovir: 02399059
  • APO-Emtricitabine/Tenofovir: 02452006
  • Mylan-Emtricitabine/Tenofovir: 02443902
  • Truvada (name-brand): 02274906

If the amount that you would have to pay is still high, you may be able to get support through the Trillium Drug Plan, see “Do you pay for some or all of your medication costs?”

Ontarians 24 years old and younger with a valid OHIP card and no private drug coverage are covered for PrEP by OHIP+.

If you are 24 years old or younger and do not have existing private drug coverage, are enrolled in OHIP and have a valid health care, you are automatically covered by OHIP+. When you are filling a prescription, show your OHIP card to the pharmacist and you will only have to pay up to $2 each time you fill your prescription.

As of April 1st 2019, Ontarians 24 years old and younger who have existing private drug coverage are not covered by OHIP+. Drug costs not covered by your private drug coverage will not be covered by OHIP+. See “Do you have private drug coverage?

Ontarians age 65 and older who have a valid OHIP card are covered for PrEP.

If you are 65 years old or over and have a valid OHIP card, you are covered by Seniors Coverage.

This program provides different levels of coverage based on your household income:

  • If you are single and earn $19,300 or less after taxes or you are part of a couple with a combined yearly income of $32,300 or less after taxes, you will pay up to $2 each time your fill your prescription.
  • If you are single and earn more than $19,300 after taxes or you are part of a couple with a combined yearly income of more than $32,300 after taxes, you will pay the first $100 of all your prescription costs per person each year and then up to $6.11 for each prescription filled or refilled.

Ontarians enrolled in these programs are covered for PrEP.

If you are enrolled in Ontario Works, the Ontario Disability Support Program, Home Care or Community Care, then you have coverage for a variety of medications, including PrEP, through the Ontario Drug Benefit program.

  • When you fill a prescription, show your OHIP card to the pharmacist and you will only have to pay up to $2 each time you fill a prescription.

People with high medication costs can get help paying for PrEP.

If you don’t have a drug plan or your plan doesn’t cover the full cost of your PrEP and you have a valid Ontario health card, you may be eligible for the Trillium Drug Program:

  • If your total annual drug costs are more than 3-4% of your household income, you can apply to the Trillium Drug Program. Your household income is based on the amount of income you earn plus the income of a partner or any other family member who you support or who supports you financially.

Another option for people who currently do not have drug coverage is to explore purchasing a private plan before starting PrEP. If you do not have any pre-existing health conditions, a private plan may be more affordable than paying for PrEP yourself or with support from Trillium. Some clinics may be able to refer you to someone who can help you figure out the best drug coverage for you.

People using the Interim Federal Health Program in Ontario are covered for PrEP.

If you are enrolled in the Interim Federal Health Program (IFHP) you have coverage for a variety of medications, including PrEP. IFHP only covers your medication costs if you do not have coverage through another government drug program or through private insurance.

  • When you are filling a prescription, show your IFHP coverage document to your pharmacist.

People eligible for the Non-Insured Health Benefits program are covered for PrEP.

The Non-Insured Health Benefits program is only open to some Indigenous people with specific legal status in Canada. First Nations people registered as an Indian under the Indian Act or Inuks who are recognized by an Inuit Land Claim organization are eligible for the NIHB, which covers PrEP. Note: NIHB only covers your medication costs if you do not have drug coverage through another government program or through private insurance.

  • If you think you might be eligible or want more information to see if you can apply, you can contact the Ontario regional NIHB office by calling 1-800-640-0642.

Canadian Armed Forces personnel are covered for PrEP through Canadian Forces Health Care.

If you are a member of the Armed Forces, you can access PrEP through health coverage you have as part of serving. While health care providers at the base, wing or unit where you are stationed may not be willing to prescribe PrEP, you can access PrEP at off-base clinics and still use your Canadian Forces Health Care Identification card (sometimes called a Blue Cross Card) to pay for PrEP and other prescriptions at community pharmacies.

  • If you do not have a Canadian Forces Health Care Identification card, call 1-866-886-1304 to ask about acquiring one. You do not have to say you plan to use your card to access PrEP.