This article was published on February 24th, 2016
Canada continues to be behind the game when it comes to HIV pre-exposure prophylaxis, or PrEP, the daily pill you can take to prevent being infected with HIV. The USA, France, and Brazil are rolling it out in force. Australians are importing generic versions from overseas and a new trial is set to expand there to include thousands of gay men at risk. Quebec is now providing it at a cost for most people of around $80/month. However, Truvada, the only drug currently proven effective as PrEP, has not yet been approved for use as PrEP in Canada with Gilead only applying last July. Even if it is approved, there is no guarantee it will be included in the provincial drug formularies or provided at an accessible cost.
Truvada is available in Canada as an off label prescription. Some private insurance plans will cover it but many either don’t cover most of the cost or don’t cover it at all. Without insurance, the retail price of Truvada is around $900CAD a month. However, there is a way to access PrEP for around $100CAD a month. This is the generic version of Truvada, otherwise known as Tenvir-EM. It contains the same ingredients as Truvada but, because of patent laws, can only be produced overseas. So you can order this drug from overseas and protect yourself. However, it requires some extra steps and a bit of effort. This is because you are not allowed to order drugs from overseas and have them shipped to Canada directly. You can have them shipped to the USA and bring them over the border though. This is how the process goes in five not so easy steps.
Step 1: Get a prescription. You first need a prescription for Truvada from your doctor. This isn’t necessarily easy as many doctors may not have heard of it and some are resistant to prescribe it. You’ll have to have a frank conversation with your doctor as to why you are at risk for acquiring HIV which likely means discussing your sex life. You may also need to provide them with information on PrEP, including the tests that you will need to have done before he prescribes it to you – including an HIV RNA test and a test for kidney function. The BC Centre for Excellence in HIV/AIDS has published guidelines to assist your doctor. If you are at high risk and your doctor won’t prescribe you PrEP, go to your local gay men’s health centre to see if they can refer you to a gay friendly doctor that understands HIV.
Step 2: Get a US bank account. To order PrEP from overseas, you’ll need a US-based credit card. And in order to get one of those, you’ll need a US-based bank account. It’s not as difficult as it sounds. Several Canadian banks have US branches. For example, TD has TD Bank which is based out of the USA. It’s technically a separate bank from the Canadian one. You can get a bank account, using your Canadian address, by either phoning the American version of the bank or submitting an application online. You do not have to have a Canadian TD account in order to do this. A simple chequing account costs about US$5.99/month. With that account, you’ll get a VISA debit card. It will function the same as a credit card, except that you’ll need funds in your account to cover the purchases.
Step 3: Get a US mailing address. You can only order PrEP from overseas to a US mailing address, not directly into Canada. For those that live close to the border, that should be easy. For those that don’t, well unless you’re willing to travel, you’re out of luck. Most US border cities have businesses that function as mailing addresses for Canadians. For example, there are at least three in the city of Blaine, Washington, just across the border from the suburbs of Canada. The cost is around $30USD for three months.
Step 4: Order the medication. Now that you’ve got your US credit card and US mailing address, it’s time to order your generic Truvada. The most reliable overseas pharmacy is alldaychemist. You’ll want to order Tenvir EM 300/200mg. This is made up of Tenofovir Disoproxil Fumarate and Emtricitabine, the two drugs that make up Truvada. The cost is $165.33USD for a three month supply plus $25.00USD for shipping.
Step 5: Pick up your medication. It will take about 2 weeks for your order to arrive at the US mailing address. Go down to it, pick it up, and then declare it at customs when you come back to Canada. You are allowed to personally import a three month supply of prescription drugs from overseas. You can only bring back your own medication, not someone else’s. You will need your prescription with you to show to customs. Be honest about what you are doing – it is perfectly legal. They will ask you the nature of your trip and tell them that you went to pick up a prescription. When asked if you could have obtained the prescription in Canada, reply that you can but as an “off label” prescription. The cost is about a $1,000 a month in Canada whereas you can access your prescription in the United States for $50.00 a month. When asked what the prescription is for, tell them that it is for the primary prevention of HIV and that this was the reason for its off-label status, as its on-label use is only indicated for HIV treatment. They will remind you that you can only pick up the next order exactly three months from today. You will not be asked to pay a tariff on it.
Let’s do the math here.
Bank account: $5.99/monthUSD
Mailing address: $30.00USD/three months or $10.00USD/month
Tenvir EM (incl. shipping): $190.33USD/three months or $63.44USD/month
Total: $79.43USD/month or $113.59CAD/month (rate: 1.43)
This is far lower than the current retail price of Truvada in Canada. So if you can go through these steps and afford $113.59CAD/month, you can start on PrEP. Make sure to continue your care with your doctor for regular testing.