PrEP now generic, as cheap as $1/day even with full cash pay! (March 2021)

As of April 1, 2021, multiple generics for emtricitabine/tenofovir DF 200/300mg (TDF/FTC, brand-name Truvada) have entered the market and driven costs down tremendously. Therefore, even full cash pay should not cost more than $40/month in SF. Prices are not yet consistent across all pharmacies, and some pharmacies may continue to quote prices as high as >$1,000+. Most should not need to pay cash, but for those who do, a solid plan is to prescribe to a pharmacy that you know consistently stocks a low-price generic. Plan B: check

A few other details:

  • Most private insurance plans in CA, including Kaiser and all Covered CA plans, now cover generic TDF/FTC for PrEP with $0 cost-sharing by the patient. This is because PrEP is now a USPSTF grade “A”-recommended preventive service.
  • Generic TDF/FTC for PrEP should not be subject to a prior authorization by almost any CA-based insurance plan.
  • Pharmacies are proactive in switching patients to generic, and most private plans now require it. There is no manufacturer coupon for the generics, so if still unaffordable, or if a patient needs financial assistance with co-payments for visits or labs, refer patients who earn <500% of FPL* to PrEP-AP.
  • Uninsured patients using the Gilead Patient Assistance Program or the federal Ready, Set, PrEP program should be prescribed brand-name Truvada with “Do not substitute” on the Rx for coverage compatibility.

For more on policy developments related to PrEP access, please review this brief. And finally, thank you for prescribing PrEP! If you would like help from SFDPH with how to prescribe PrEP or get OOP costs covered, please contact the City Clinic Biomedical Prevention Coordinator at

*500% of FPL is $64,400 in annual income, as of April 30, 2021

For the full monthly report this editorial appeared in, please visit Department of Public Health - Research, Health Assessments & Data ( webpage and scroll down to San Francisco Monthly STI Reports.