Accessing PrEP Coverage (& a Prescriber)
Accessing Publicly Funded PrEP through Alberta Health
Those who:
Meet the Alberta PrEP eligibility criteria, and
Have Alberta Health Care
are eligible to receive generic versions of PrEP at no-cost through Alberta Health’s publicly funded PrEP program.
While any physician or nurse practitioner in Alberta can prescribe PrEP, to access PrEP through Alberta Health’s publicly funded PrEP program, individuals must receive a prescription from a designated prescriber. Designated prescribers have undergone additional training to ensure they are best prepared to care for people on PrEP. A list of designated prescribers can be found here.
Note: Not all prescribers on the list are taking new patients, meaning you may need to contact multiple prescribers to find one who is able to meet with you. If you currently have a family doctor or nurse practitioner who is not on the list of designated prescribers, they can become one by completing a free online module and a brief application form. More information about this process can be found here.
A full list of eligibility criteria can be found in the Alberta PrEP Guidelines. A brief overview is provided below:
Eligibility criteria for men who have sex with men (cis and trans), trans women, and gender diverse people
PrEP might be considered if they have had anal sex without a condom in the last six months, in addition to any of the following:
Syphilis, gonorrhea, or chlamydia diagnosis in the past year
Use of non-occupational post-exposure prophylaxis (nPEP) more than once
Ongoing sexual relationship with a partner who is HIV-positive with risk of transmission or a partner who’s HIV status is unknown, but they are part of a population that has higher rates of HIV (i.e. men who have sex with men, people who inject drugs, or people from countries with a high prevalence of HIV a list of these countries can be found here.)
A HIRI-MSM risk score of equal or over 11. The HIRI-MSM risk assessment is used by some prescribers use to determine HIV risk amongst men who have sex with men. You can calculate your HIRI-MSM risk score here.
Eligibility criteria for heterosexual people
PrEP is recommended for HIV-negative partners in an ongoing relationship with an HIV-positive person, where the HIV-positive person has substantial chance of transmitting HIV. Examples include:
The HIV-positive partner has a detectable HIV viral load (over 40 copies of HIV/ml of blood)
The HIV-positive partner’s viral load is ‘usually’ undetectable but they have an STI at time of sexual contact, which can increase the likelihood of transmission
The partner’s HIV status is unknown but they are part of a population that has higher rates of HIV (i.e. men who have sex with men, people who inject drugs, or people who are from a country with a high prevalence of HIV - a list of these countries can be found here.)
Eligibility criteria for people who inject drugs
PrEP may be considered when there is current or anticipated sharing of injection drug equipment (i.e. needles, syringes, spoons, etc.) with a person who could transmit HIV. This could include:
Someone with a detectable viral load (over 40 copies of HIV/ml of blood)
Someone whose HIV status is unknown but they are part of a population that has higher rates of HIV (i.e. men who have sex with men, people who inject drug, for people who are from a country with a high prevalence of HIV - a list of these countries can be found here.)
PrEP Coverage for First Nations and Inuit People
Eligible First Nation and Inuit people who receive health benefits through Non-Insured Health Benefits (NIHB) can access publicly funded PrEP either through Alberta Health’s program or directly through NIHB.
If accessing PrEP coverage through Alberta Health, individuals will follow the same process outlined above.
If accessing PrEP coverage through NIHB, individuals are not limited to prescribers on the designated prescriber list, meaning they can obtain prescriptions from physicians and nurse practitioners not on the list and still receive full PrEP coverage.
Also, because PrEP is not being accessed through the provincial program, the eligibility criteria in Alberta’s PrEP Guidelines may not apply.
Other Types of Insurance Coverage
For those who cannot access publicly funded PrEP through Alberta Health or NIHB, they can:
Attempt to access coverage through their private insurance plan. In this case, the individual should consult with their private insurance or group benefits plan to see if their current plan provides coverage for PrEP and what process they might have to undergo to have PrEP covered.
If no private insurance or group benefits are available, an individual may have to pay for PrEP out-of-pocket. This can be prohibitive, with even generic versions of PrEP costing approximately $250 for a 30 pill supply.
Support for accessing PrEP can also be offered to those who are eligible for it through various community supports.
A note for refugee claimants: The Interim Federal Health Program provides limited, temporary coverage of health-care benefits to people in the following groups who aren’t eligible for provincial health insurance:
protected persons, including resettled refugees;
refugee claimants; and
certain other groups.
Unfortunately, the Interim Federal Health Program does not provide coverage for PrEP.