Mistr vs Nurx vs ?

[+ jessmapex]

I am considering going on PreP. 

I have health insurance through my employer and a regular primary care physician I see. But i dont want to ask her to prescribe PreP. I checked with my insurance provider. They cover Truvada generic for $0 and Discovey for $50. I have read the thread on Truvada vs Discovey.  

To get the prescription, I am considering Mistr or Nurx. Given Mistr is a Florida outfit and they offer initial testing for $0,  I am a bit suspicious. Nurx seems to have better reviews. What are your experiences? Would you recommend one vs the other? Or someone else altogether?

Another thought is..I have been hiring for last 22 yrs. I am an oral and anal top. I always use protection if i top a guy. I haven't caught anything serious yet. So, may be the practice I follow is sufficient and I don't need PreP ?

Would appreciate feedback from other folks here (except Nurx, Mistr marketeers, if any here).

Edited August 31, 2023 by jessmapex

[SirBillybob]

I cannot weigh in on 3rd party testing / dispensing, but I likely wouldn’t take PrEP if exclusively insertive with condom protection. My tenofovir-emtricitabine uptake as versa is based on occasional receptive anal with consistent condom protection.

The key clinical factor in your case, due to insertive oral, if unprotected, is screening for other STIs. I assume that if you get tested for them it is not through your physician, as otherwise it might make sense to address PrEP with her although I can understand that reluctance is justifiable. 

It is also prudent to inform your physician of all medications that you take. If not, you will need to micromanage potential drug interactions and contraindications, adverse events, ie, researching this knowledge; consider alterations in blood chemistry that she may detect doing the clinical work she needs to execute without being hamstrung, without compromising the care relationship, and so on. 

Edited August 31, 2023 by SirBillybob

[Guest]

16 hours ago, jessmapex said:

...I have health insurance through my employer and a regular primary care physician I see. But i dont want to ask her to prescribe PreP. I checked with my insurance provider....I am an oral and anal top. I always use protection if i top a guy...

My first question would be why you don't want your PCP to prescribe PrEP. These medications are easy, everyday, bread-and-butter primary care medications. Are you afraid you'll get a hostile response? If so, I highly suggest you get another PCP (of course, I'm assuming you don't live in the rural Bible belt, in which you may have no choice?). Since you're a top, my next question would be your reasoning behind going on PrEP. If your plan is to stop using condoms, then you'd be reducing a tiny risk of getting HIV while exposing yourself to a much larger risk of getting exposed to all kinds of other STD's. Even if you're planning to continue using condoms, you still have to weigh the (very low) risks of medication injury vs the (also very low) risk of contracting HIV as a condom-wearing top. Are you hiring a new escort on a weekly basis? If so, then adding the PrEP might make sense. If you hire only several times a year, however, the risk/benefit ration becomes more dubious. 

[TorontoDrew]

Not really on topic but the Mistr guys are really hot.

[+ jessmapex]

4 hours ago, Unicorn said:

My first question would be why you don't want your PCP to prescribe PrEP.

I live in the suburbia. Originally i chose a PCP based a recommendation from a friend and because of her prior work with HIV and the gay community. But last year she half retired due to some health issues. They assigned a new PCP.  The practice and the new PCP does not seem particularly oriented toward gay men and their issues. Once, my original PCP was out of office and I had something I thought was an STI. When I told the nurse practitioner about it, it seemed like it was a scandal around the office. The NP did a urine test in the office and the aides gave me dirty looks. That practice is used to family patients. I interpreted the dirty looks as them saying - you cheating bastard or something to that effect. So for PreP, I would rather seek someone who is familiar with the gay lifestyle and is non-judgemental. In San Francisco there are practices like that, but the suburbs around SF are very family oriented.

 

4 hours ago, Unicorn said:

Since you're a top, my next question would be your reasoning behind going on PrEP.

A friend of mine, who is a bttm and HIV poz, told me his boyfriend, who is a top, gave him HIV. He said his bf got it from getting oral sex. Although i know the chances of getting it through top oral sex are miniscule, I get paranoid after every meeting with a provider. Lately, I am also enjoying getting deep-throated and a lot of guys, because they think i have a good dick, love to suck on it very deep.

In last few years, i am topping (protected) quite a bit. Before that i rarely got into insertive anal sex in any position. Finally, one of these days, I do want to experience bareback topping..since i have never done it.  I want to enjoy sex at least once as nature intended.

So i decided PreP is in order to get some peace of mind and perhaps explore bareback at least once with someone trustworthy.

Edited September 1, 2023 by jessmapex

[Guest]

59 minutes ago, jessmapex said:

...When I told the nurse practitioner about it, it seemed like it was a scandal around the office. The NP did a urine test in the office and the aides gave me dirty looks...

Yikes!! That's really off-base. I would strongly encourage you to get a new PCP. That behavior's quite unprofessional. Your PCP absolutely needs to know all of the meds you're taking--without judging you. If you only want to bareback once, you may use post-exposure prophylaxis or on-demand PreP; you don't need to take it long-term. 

PrEP 2-1-1 - San Francisco AIDS Foundation

WWW.SFAF.ORG

---

PrEP 2-1-1, or “PrEP on-demand,” is effective at preventing HIV for people having anal sex. More info about how to take PrEP around when you have sex.

 

Edited September 1, 2023 by Unicorn

[RyanDean]

I switched to MISTR about six months ago and have been very pleased with the convenience.

When I started on Prep maybe five years ago, my PCP referred the supervision of Prep to a different doctor at an infectious disease practice. Was all fine, though the scheduling was complicated (the doctor only took appointments one day a week) and the practice required a second appointment with another office for blood/urine work, then there were some billing hassles... And coming back after COVID, the scheduling hassles just increased, even though they were 5minute tele-medicine appointments.

Right when I was hitting my limit with these hassles, I ended up hiring a gent who happened to a MISTR spokesmodel. (He wore his MISTR trucker hat to our meetup.) So I asked him about the service. His pitched emphasized how the company was mostly about trying to ease access for more people, which I found intriguing, so I looked into it further and found that I liked MISTR's business model (ie using grants to pay for prescriptions for uninsured clients & leveraging the payments from insured clients to subsidize others). So I gave it a go.

Two prescription cycles later I'm very pleased. The very communicative and responsive MISTR team worked very hard to try to eliminate my modest copay altogether but my insurance insisted on the same co-pay for the same generic Truvada as I was getting with my specialist. (My insurer refuses to pay for Descovy, which both my specialist and MISTR tried to go with.) Plus, with MISTR, I don't have the visit co-pays for either the specialist or the bloodwork appointments, so it definitely ends up costing me less there (an annual savings of roughly $250). I'm still getting used to swabbing myself for the testing, which my state requires fairly frequently, but it's easy enough. I also have direct access to my test results, which I didn't always with my previous specialist.

So I've had no complaints with MISTR so far, and sincerely hope it's able to keep on doing what it's doing...
 

[Guest]

Thanks for the great recommendation, @RyanDean. Boy, there sure are some lazy-ass PCP's out there. You really got referred to an ID specialist for this? It's not rocket science. Before starting, just check for HIV, Hep B/C antibodies, kidney function, and other STD's. Labs even have "PrEP panels" so no one even has to use his brain cells. Then just check for HIV antibodies and kidney function (and probably STD's) every 3 months. It's not the least bit complicated (for Truvada, maybe a bone density scan after 3-4 years). 

[+ FrankR]

I have recommended Mistr before and continue to be happy with the convenience and service. 

[+ jessmapex]

Another question: I work for a well-known company with a global footprint and liberal company policies. Do you guys think using my employer provided insurance for my PreP would jeopardize my employment in any way? The political and social environment in the US is currently seem to be turning pretty hostile toward sexual minorities. 

[SirBillybob]

57 minutes ago, jessmapex said:

Another question: I work for a well-known company with a global footprint and liberal company policies. Do you guys think using my employer provided insurance for my PreP would jeopardize my employment in any way? The political and social environment in the US is currently seem to be turning pretty hostile toward sexual minorities. 

I would venture to say that the company’s philosophy may be irrelevant, depending on …

The medication uptake for a total employee constituency could be measured in total costs and fed back to the policy purchaser for fiscal purposes, but medical insurance as I understand it is subject to the same confidentiality as is required of licensed health professionals. A physician is usually the face of supervision of insurance claims adjudication related to eligibility, etc.

A small company could conceivably know of a sudden uptick in utilization owing to an individual’s changed health circumstances. I am not sure if it would be stratified pharmacologically or collapsed within other insured professional services contained in the insurance contract. 

I have known HIV patients working in small outfits that felt backed into a corner related to expensive antiretroviral medication insurance claims because they feared being profiled, that is, assumptions made about who among the team suddenly has an expensive and undisclosed illness. They were usually young and perhaps out viz orientation, but many typically younger heterosexual men and women as well. 

Even patients working in large companies where an upward blip in professional costs would be absorbable within the overall annual sum of services paid out often required considerable reassurance. They sometimes phoned, say, Clarica, SunLife, ManuLife, GreenShield, Blue Cross, etc, at the outset, to confirm confidentiality. Small company policy premiums are often pooled into groupings of smaller outfits in order to manage random hits to HR budgets, and that was often assessed as well.

It is illegal in some provinces in Canada to tap into the public payer based coverage assistance system without first using all private insurance options possible.

All this is to say that using your workplace insurance is likely failsafe as far as confidentiality and the risks of red-flagging. I expect that PrEP, particularly taken intermittently (on-demand) would be of a cost magnitude that would not raise eyebrows compared to many other drug costs. No spreadsheets of what employee filled what medication prescriptions. 

Edited September 1, 2023 by SirBillybob