PrEP from Nurx

[David1024]

So I finally decided to get on PrEP, but wanted to do it as discretely as possible. Nurx makes it really easy, but as far as I can see, they only operate in the US and not in every state. They sent me a home testing kit for a urine sample, blood sample, throat swab and anal swab (women also get a vaginal swab). I mailed back the samples and swabs, got the results quickly and they prescribed the meds. The testing cost $15 for the copay, but the meds did not come quite as cheaply. I had a copay of $420 for a 90 day supply. I got a generic for Truvada and so far, no side effects at all. I used to pay for a private STD test fairly regularly, so it probably won’t cost me too much more as I will likely need to get tested every 3 months before getting a new prescription  

The one thing that surprised me was that I went for my annual physical last week and my doctor had on record that I was taking Truvada. I don’t think I gave any info on my primary care physician when registering with Nurx, so just curious how the information got transmitted. It’s not a big deal for me, just a surprise I wasn’t expecting. 

[+ BenjaminNicholas]

6 hours ago, David1024 said:

The one thing that surprised me was that I went for my annual physical last week and my doctor had on record that I was taking Truvada. I don’t think I gave any info on my primary care physician when registering with Nurx, so just curious how the information got transmitted. It’s not a big deal for me, just a surprise I wasn’t expecting. 

Did they do blood work as part of the physical?

If so, of course they know. 

[+ keroscenefire]

6 hours ago, David1024 said:

 The testing cost $15 for the copay, but the meds did not come quite as cheaply. I had a copay of $420 for a 90 day supply. 

 

This is very cheap for both the testing and for the meds. I have insurance and it costs me generally a couple hundred for the testing and several hundred dollars for a three-month supply. There are some newer, cheaper Truvada generics though so it actually has gone down every time I get it prescribed. Although the last time I got the drug, I hit my deductible so it was cheaper. My insurance just renewed though so I'm interested to see what'll be now that my deductible is back. 

[+ robear]

Keep in mind that for those with commercial insurance (not Medicare or any other gvt program) prescribed brand-name Descovy (and probably Truvada, even though that is now usually filled with a generic), the manufacturer's program waives the copay when filled at a retail pharmacy.  My $75 copay is waived every month, I pay nothing OOP for PreP.

https://www.gileadadvancingaccess.com/copay-coupon-card

 

[LookingAround]

All medications you are on are part of a national database so any physician or nurse practitioner with a computer can access it and see what meds you’ve been prescribed. 

[+ sniper]

I think health systems communicate more these days and with prescriptions in general being fine electronically your doctor is probably accessing the same database as your medication provider. 

[MikeBiDude]

4 hours ago, LookingAround said:

All medications you are on are part of a national database so any physician or nurse practitioner with a computer can access it and see what meds you’ve been prescribed. 

 

4 hours ago, sniper said:

I think health systems communicate more these days and with prescriptions in general being fine electronically your doctor is probably accessing the same database as your medication provider. 

And these are good things RE: drug interactions - as patients aren’t always 100% forthcoming. As evidenced in this thread.

[josh282282]

15 hours ago, LookingAround said:

All medications you are on are part of a national database so any physician or nurse practitioner with a computer can access it and see what meds you’ve been prescribed. 

I'm a primary care physician in the US and I have literally no idea what you are talking about. Sure, I'd LOVE to have some national database I could access, and it would help so much in providing good care, but alas, there is no such monster. 

There might be large medical groups that doctors within that group can access the records, such as in the VA, but that's only for the physicians within that organization. Non-VA doctors cant access the VA records. But a national database of meds listing what each patient takes available on the internet to every doctor or mid-level? Nope. I dont know everything & haven't seen everything, but I'm sure I wudda heard of something like this if it were professionally available to me. 

The OPs question on how did one medical organization (Nurx) communicate with the other (his PCP) is a question I'd like answered, too. But I think theres gotta be more to the story. A lot more...

[+ Charlie]

On 8/24/2021 at 9:13 PM, Benjamin_Nicholas said:

Did they do blood work as part of the physical?

If so, of course they know. 

? ?

My gay primary care doctor does extensive blood tests in preparation for my physical, but he still has to ask me what medications and supplements I am taking.

[MikeBiDude]

I wish Medicare would approve a generic for Truvada and add to their formulary. Even though right now as of July I’m at the “catastrophic” level on my plan and only pay about $95 for Truvada, the early months of this year were painful, $600! The Medicare coverage averages out to $250-300/month annually its certainly not a deal breaker for me….but when a couple other prescriptions I pick up are sometime $5-10 makes me wish the generic arrives sooner than later. 

 

[marylander1940]

On 8/24/2021 at 5:53 PM, David1024 said:

So I finally decided to get on PrEP, but wanted to do it as discretely as possible. Nurx makes it really easy, but as far as I can see, they only operate in the US and not in every state. They sent me a home testing kit for a urine sample, blood sample, throat swab and anal swab (women also get a vaginal swab). I mailed back the samples and swabs, got the results quickly and they prescribed the meds. The testing cost $15 for the copay, but the meds did not come quite as cheaply. I had a copay of $420 for a 90 day supply. I got a generic for Truvada and so far, no side effects at all. I used to pay for a private STD test fairly regularly, so it probably won’t cost me too much more as I will likely need to get tested every 3 months before getting a new prescription  

The one thing that surprised me was that I went for my annual physical last week and my doctor had on record that I was taking Truvada. I don’t think I gave any info on my primary care physician when registering with Nurx, so just curious how the information got transmitted. It’s not a big deal for me, just a surprise I wasn’t expecting. 

Good for you!

Here's my alternative advice:

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Just ask your Doctor every 3 to 6 months according to how active you're for an STD test and I would suggest every 3 months for a comprehensive metabolic panel. 

 

[rvwnsd]

On 8/24/2021 at 2:53 PM, David1024 said:

So I finally decided to get on PrEP, but wanted to do it as discretely as possible. Nurx makes it really easy, but as far as I can see, they only operate in the US and not in every state. They sent me a home testing kit for a urine sample, blood sample, throat swab and anal swab (women also get a vaginal swab). I mailed back the samples and swabs, got the results quickly and they prescribed the meds. The testing cost $15 for the copay, but the meds did not come quite as cheaply. I had a copay of $420 for a 90 day supply. I got a generic for Truvada and so far, no side effects at all. I used to pay for a private STD test fairly regularly, so it probably won’t cost me too much more as I will likely need to get tested every 3 months before getting a new prescription  

The one thing that surprised me was that I went for my annual physical last week and my doctor had on record that I was taking Truvada. I don’t think I gave any info on my primary care physician when registering with Nurx, so just curious how the information got transmitted. It’s not a big deal for me, just a surprise I wasn’t expecting. 

It is possible that your physician obtained that information from your insurance company's pharmacy benefits manager (PBM). The PBM will have a record of every pharmacy claim which, of course, includes the name of the medication you were prescribed.

Why you don't get your Truvada/Descovy prescriptions from your physician? 

[+ BenjaminNicholas]

4 hours ago, Charlie said:

? ?

My gay primary care doctor does extensive blood tests in preparation for my physical, but he still has to ask me what medications and supplements I am taking.

I mean, would it be possible that a script like PrEP would show up on routine blood work as a maintenance drug.

It's likely, but since I only play a doctor on television, I'm unsure.

[+ robear]

Not a doctor, but I think FORENSIC blood analysis can detect the presence of medications, but routine blood testing would not show any such detail.

[Colton]

20 hours ago, josh282282 said:

I'm a primary care physician in the US and I have literally no idea what you are talking about. Sure, I'd LOVE to have some national database I could access, and it would help so much in providing good care, but alas, there is no such monster. 

There are state databases. New York for example.  Tracks all prescriptions. 

[HotWhiteThirties]

I understand the medical profession's desire to know all things - mostly for altruistic reasons - but I'm sorry, the individual person's rights to privacy, in spite of the risks that might create, should prevail. That may frustrate a physician, but their perceived "need to know" should always be checked, IMO, by the desires of the individual's rights and intentions. If the patient doesn't want them to know every medication they take, then for better or worse, that should be up to the patient. The attitude that "someone else knows better," is a slippery slope. Of course, so much of this lack of privacy, is encouraged by insurance companies who make all of this data available to all. And the individual patients simply comply and allow their privacy rights to be signed away in something akin to a "terms of service agreement," that few read and ultimately waive the privacy they think they are being afforded. 

[LookingAround]

1 hour ago, Colton said:

There are state databases. New York for example.  Tracks all prescriptions. 

That’s what I meant

[+ IronMaus]

"Recent federal guidance says health insurance companies must cover all of the costs for the treatment, including the medication, doctor's visits, and lab tests."

I understand you want to be discreet, but thought you should know. There are also websites to order these meds through India via Canada.

There is also a way to stretch these pricey drugs a lot further: The 2-1-1 method. Take two pills 2-24 hours before sex, one pill 24 hours after the initial dose, and one final pill 24 hours later. This works just as well as taking it every day and can help a one-month or 90 day supply last a lot longer if you aren't having sex weekly or more. The FDA hasn't done extensive studies or approval on this, but other countries are way ahead of us on this.

Soon there will be injections and implants for PrEP, lube to prevent the other STIs, and the HIV vaccine is (still) on the horizon.

Also, it's worth mentioning that taking 200mg of Doxycycline within 24hours of sex greatly reduces chances of Chlamydia, Gonorrhea, and Syphilis. This is called Doxycycline PEP and its still in a study phase but the results are incredible.

[+ 7829V]

Oh wow. For me prep is free. And they offer it for free to anyone here in San Diego county. 🙂

[+ BenjaminNicholas]

14 hours ago, IronMaus said:

Also, it's worth mentioning that taking 200mg of Doxycycline within 24 hours of sex greatly reduces chances of Chlamydia, Gonorrhea, and Syphilis. This is called Doxycycline PEP and its still in a study phase but the results are incredible.

Yes, 2-1-1 is definitely an option, but it also requires some forethought and hindsight.  One pill a day might not be cheaper, but it's easier to remember.

DoxyPEP still needs further randomized controlled trials.  It works for chlamydia and syphilis, but is imperceptibly useful with Gonorrhea (as that STD has continued to mutate and is resistant to an older tetracyclines like Doxy).

The other issue is long term use and antimicrobial resistance.  That's especially dangerous with something like staph.

On a more minor scale, there's also the side-effects of Doxy when used long term.  UV sensitivity, skin problems, stomach issues.

 

[+ robear]

On 8/26/2021 at 12:07 PM, MikeBiDude said:

I wish Medicare would approve a generic for Truvada and add to their formulary. Even though right now as of July I’m at the “catastrophic” level on my plan and only pay about $95 for Truvada, the early months of this year were painful, $600! The Medicare coverage averages out to $250-300/month annually its certainly not a deal breaker for me….but when a couple other prescriptions I pick up are sometime $5-10 makes me wish the generic arrives sooner than later. 

 

Have you tried running the numbers using the GoodRx discount?  That is, skipping insurance/Medicare altogether and just paying the discount pharmacy price? I know it's complicated factoring in the lost credit toward deductibles and so forth, but a number of big retailers offer a monthly price of ~$45 for Truvada (but not Descovy apparently). Might be worth a look.

https://www.goodrx.com/truvada

 

[MikeBiDude]

58 minutes ago, robear said:

Have you tried running the numbers using the GoodRx discount?  That is, skipping insurance/Medicare altogether and just paying the discount pharmacy price? I know it's complicated factoring in the lost credit toward deductibles and so forth, but a number of big retailers offer a monthly price of ~$45 for Truvada (but not Descovy apparently). Might be worth a look.

https://www.goodrx.com/truvada

 

Thanks….this is a good suggestion and I’ll check it out. Coupon for a 90 day supply at a local supermarket pharmacy is $120! That’s a great price!

[David1024]

On 8/26/2021 at 6:46 PM, robear said:

Not a doctor, but I think FORENSIC blood analysis can detect the presence of medications, but routine blood testing would not show any such detail.

The doctor asked the question and knew about it before I had my blood work done, so it was definitely some sort of shared information or database. 

[+ sniper]

It was most likely your health insurance data, assuming you put the medication through your insurance. It's also possible that the doctor behind the scenes of your website belongs to the same medical group as your doctor. Most medical practices these days, even if they look like they are solo practitioners, are actually part of a larger group or hospital system. Short of going to a free clinic and giving a fake name, or a lone doctor who doesn't take insurance and sticks to paper records, I'm not sure it's really possible to prevent this sort of thing.

[David1024]

Thanks for the comments and insights. It’s not really a big deal for me, I was just surprised when my doctor mentioned it.