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AB PrEP Coverage Decision

What You Need to Know

Starting October 1, 2018, Alberta Health will provide full coverage for generic versions of PrEP for eligible Albertans. To access this coverage, individuals must: 

1) Have Alberta Health Care (individuals may be required to produce their Alberta Personal Health Care Card to be eligible for coverage)

2) Meet the eligibility criteria as laid out in the provincial PrEP guidelines.

 

First Nations and Inuit individuals with Alberta Health Care may also access coverage through the provincial program. However, it should be noted that eligible First Nations and Inuit can continue to access full PrEP coverage through Non-Insured Health Benefits (NIHB), under the First Nations and Inuit Health Branch (FNIHB).

 

Who meets the eligibility criteria for publicly funded PrEP under the provincial PrEP guidelines?

[Note: This language is pulled directly from the provincial PrEP guidelines and may differ from the language some people use to describe their experiences]

1. MSM, Trans Women and Gender Diverse People

  • Condomless anal sex within the last 6 months and any of the following: 

    • Infectious syphilis or bacterial STI (gonorrhea or chlamydia) in the past 12 months. This recommendation is expanded from the Canadian criterion specifying rectal bacterial STI given the limited uptake of extra-genital testing in Alberta).

    • nPEP (non-occupational HIV post-exposure prophylaxis) more than once

    •  Ongoing sexual relationship with HIV-positive partner(s) with substantial risk of transmissible HIV (ie-viral load detectable; >40 copies/mL* or HIV status unknown but from a higher risk population- eg MSM, PWID)

    • HIRI-MSM risk score ≥ 11 (HIV Infection Risk Index for MSM; see Appendix A: HIRI-MSM risk assessment tool)

  • Not indicated for those in a monogamous relationship with a single partner with no or negligible risk of having transmissible HIV (e.g. HIV negative, HIV positive but virus suppressed with viral load ≤ 40 copies/mL, or HIV status unknown but risk profile similar to the general population (Tan et al 2017)).

  • Gender diverse people are included in the eligibility criteria as incorrect assumptions can be made about sexual practices of individuals.

2. Heterosexual People

  • Recommended for the HIV-negative partner in an ongoing relationship with an HIV-positive partner involving condomless vaginal or anal sex, where the HIV-positive partner has a substantial risk of having transmissible HIV (ie-detectable viral load*)

  • Consider PrEP in similar situations where the HIV-positive partner has a lower, but non- negligible risk of transmissible HIV:

    • viral load detectable (>40 copies/mL*) or

    • viral load usually undetectable* but concomitant STI present at time of exposure (recognizing that undetectable viral load gives a very low likelihood of transmission, but the presence of an STI may increase the presence of virus in ulcers (Boily MC et al 2009) or at mucosal surfaces), or

    • HIV status unknown, but from a high-prevalence population- MSM, PWID, countries with high HIV prevalence

 

3. PWID (People Who Inject Drugs)

  • PrEP may be considered when there is ongoing or anticipation of ongoing sharing of injection drug use paraphernalia (needles, syringes, spoons, foil, cotton filters etc.) with a person with a non-negligible risk of HIV infection:

    • Detectable viral load* or

    • HIV status unknown but from a high-prevalence population- MSM, PWID, countries with a high HIV prevalence.

 

*for the purposes of this document, an undetectable viral load is defined by 2 sequential measurements of HIV viral load <40 copies/mL on at least 2 occasions separated in time by 4-6 months.

 

For more information on whether PrEP is right for you or your patient visit our “Is PrEP right for you?” page (for community members or "Assessing for Eligibility" page (for patients). And if you have any other questions, please do not hesitate to contact us here.

 

 

Who is eligible to prescribe publicly funded PrEP?

In order for a patient to access PrEP coverage through Alberta Health, they must receive a prescription from a designated prescriber. Currently, only physicians and nurse practitioners are eligible to become designated PrEP prescribers as it relates to the province’s publicly funded PrEP program.

 

To become a designated prescriber, those eligible must complete a module (with online and in-person deliveries), after which they will be added to the designated prescriber list. For those with significant experience prescribing PrEP in the past, an exception to the module may be permitted.

 

For eligible prescribers interested in being added to the designated prescriber list, they should fill out the Designated Prescriber Application form found on the AHS PrEP page.

 

Any prescriptions provided by non-designated prescribers will not be eligible for coverage under the provincial PrEP program. If you are currently being prescribed PrEP and would like your prescriber to be contacted about these new requirements, please complete the following google form

For a current list of designated prescribers, click here.

To visit the AHS PrEP webpage, click here.

 

Currently, this is not a requirement for individuals who are obtaining PrEP coverage through Non-Insured Health Benefits or for those who obtain private insurance coverage for PrEP or pay out-of-pocket.

 

What about those who do not meet the eligibility criteria or cannot access coverage through Alberta Health or Non-Insured Health Benefits?

Unfortunately, we recognize that not everyone who lives in Alberta will be eligible for publicly funded PrEP coverage. In this case, individuals will likely have to pay out-of-pocket or obtain coverage through a private insurer. To learn more about alternative coverage pathways, visit our coverage section here.