In the USA, Gilead, the branded manufacture of Truvada, the original PrEP pill, is the only version that is allowed to be sold directly at the moment. Unfortunately it can be as much as $1700 USD per bottle or months supply. Though the rules are fuzzy and dependant on an FDA officer's assessment at the time, it is possible to buy and import the much cheaper and much more affordable generics from overseas. They are bought outside the country, online, and delivered to your US address. See the list of suppliers who you can do that through in our Buy PrEP Section. Because the assessment of the import is designed around personal use, 3 months at a time is the recommended maximum buy. Buying more might look more like a commercial importation for resale.
Recently a generic version of PrEP by Teva has been approved for prophylactic (HIV preventative) use by the FDA. Unfortunately this doesn't remove the copyright that Gilead holds and the Teva product maybe subject to deals with Gilead that make its availability or price still a barrier. Its watch and see.
PrEP is covered by most health plans and is free in some cities.
Is a Prescription Needed
A prescription is needed to get your PrEP order via insurance companies that cover it and from pharmacies in the USA. If you are personally importing generic PrEP then it is not a requirement. See Prescribing Doctors to find a GP or clinic that is PrEP-aware and will write your script for you. Its recommended you go back each 3 months for a new script and your doctor will test to makes sure you are still HIV negative, for STIs and your kidney function to make sure your body is working well and can handle long term medication.
How to get PrEP
There are four ways to get PrEP in the USA. Basically if you can get to a PrEP proscribing doctor then you can get PrEP one way or another and even free if you are struggling to afford it.
You can walk into a pharmacy that stocks Truvada, the Gilead version of PrEP, and buy it over the counter with your prescription. It is very expensive and outside the means of most people in the USA. Truvada for PrEP is covered by many private insurance plans and by Medical If there are residual amounts Gilead has a "co pay scheme" and in most cases it will be at zero cost overall. http://www.truvada.com/truvada-patient-assistance.
Cities that provide it free
Some cities have taken the initiative to provide free PrEP or assistance getting PrEP.
San Francisco: http://www.sfhiv.org/resources/prep/
PrEP Watch list PrEP assistance organisations and serivces by state. http://www.prepwatch.org/us-local-programs/
Personal Importation (buy overseas and have delivered)
This method is available to all those in the USA no matter where they live in the nation. The cost is currently as low as $85.15 USD for a 3 month supply (90 pills) delivered to your door. Its recommended you only buy 3 months at a time to keep with in the FDA guidelines regarding "personal use". The FDA guidelines regarding personal importation are fuzzy and subject to the assessment of the FDA agent checking the package at the time. In practice it is rare for a delivery to have any issues. There have been instances where additional documentation like ID images is requested.
Free PrEP through the Green Cross Pharmacy low income scheme
One of the online suppliers, Green Cross Pharmacy, run a scheme to provide free PrEP to people on low incomes. Normally Green Cross Pharmacy partner with a local community organisation who will do the assessments and make recommendations on genuine need and coupon allocation. Currently there is no such organisation in the USA but you could still supply proof of low income and statement of your need direct to and it will be assessed internally.