How to Access PrEP Without Insurance in Vancouver (for $65 CAD Per Month)

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Disclosures: the author is not affiliated with the websites, organizations, pharmacies or medication described in this tutorial. The author has no financial interest in people obtaining PrEP by these or any other means. The author is a concerned citizen who feels that people who could safely benefit from PrEP, under supervision of their doctor or nurse practitioner, should be able to access it at a reasonable cost.

Disclaimer: the author is not providing medical advice and is not responsible for any undesirable outcomes such as financial, legal, or health problems. PrEP is known to have side effects and it is not 100% effective at preventing HIV infection.

News:
In order to de-clutter the front page, I have created a News page for announcements
2017-Jun-11: A new research study measuring drug levels of generic PrEP has launched in Vancouver. Click here to learn more.

Introduction: 

Pre-exposure prophylaxis (PrEP) is the use of daily anti-HIV medication by people who are HIV-negative but are at risk for HIV infection. Research studies have shown that people who took PrEP were 86% (and may be up to 99%) less likely to become HIV-positive than those who did not take PrEP.

Currently, the only oral medication approved to prevent HIV is emtricitabine/tenofovir 200/300mg, also known as Truvada®. Currently, in British Columbia, the cost of this medication is covered completely when used to treat HIV, but is not covered at all for use as prevention. This is problematic because Truvada® costs nearly $1000 per month to purchase out-of-pocket. Many people at-risk of contacting HIV do not have third-party health insurance, and fewer have insurance that will agree to cover Truvada® for prevention.

For more information about what PrEP is, how it works, who should consider taking it and what are its side-effects, please see the following resources:

To learn more about other strategies for HIV prevention such as condoms, Treatment as Prevention (i.e. undetectable HIV viral load), routine testing, post-exposure prophylaxis (PEP), and sero-sorting/positioning, check out TheSexYouWant.ca by the Gay Men’s Sexual Health Alliance of Ontario.

The rest of this site assumes the reader has basic knowledge about PrEP and provides a step-by-step guide for people in Vancouver, BC, who do not have insurance coverage for PrEP to import a generic version from a foreign pharmacy for approximately $65 CAD per month.

People elsewhere in the country can also follow this guide by substituting information relating to their area, which is found on the page called Other Canadian Cities

A quick overview of the process:
       (start with See MD/NP)

DBCcycle

To complete this process as described, you will need: 

  • a family doctor or nurse practitioner
  • provincial medical coverage (BC MSP) in order to see and MD/NP and for lab tests to monitor safety and effectiveness
  • a Canadian credit card or a PayPal account
  • at least $120-195 CAD available funds (depending on supplier chosen)
  • a valid passport
  • a way to get to Point Roberts, WA, USA (a driver’s license or a friend with a license/passport/car) (public transit instructions added here!)
  • no criminal record that would prevent entry to the USA

Step One: Getting a Prescription

Even though you are buying the medication from abroad, you still need a valid prescription to order it online and to import it to Canada. More importantly, PrEP still needs to be diligently monitored for safety and effectiveness, regardless of where the prescription is filled. You must be monitored with blood/urine tests every three months for rare but known adverse events including kidney problems, bone density loss, HIV seroconversion and drug resistance.

If you do not have a family physician or nurse practitioner
You can find one at the BC College of Physicians website. Here are the settings to select to find a GP in Vancouver.

If your primary care provider (PCP) is not experienced in prescribing/monitoring PrEP
You can print out and bring the Guidelines for the use of Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV acquisition in British Columbia by the BC Centre for Excellence in HIV/AIDS to assist him/her. You can also use the US CDC PrEP Guideline which is more thorough, but be warned it is 67 pages.  You can also ask him/her to refer you to a specialist or another care provider who has experience in this area.

Still having problems finding a care provider?
If you need assistance finding a PCP, or if you need a referral to a specialist because your doctor is still not comfortable with PrEP due to lack of experience with it, or doesn’t know a specialist to refer you to, the nurses at the HIM Clinics will be able to assist you.
UPDATE 30-Mar-2017 for Vancouverites: There are now three physicians seeing patients for PrEP at HIM on Davie at varying times during the week. To see one of these doctors for PrEP, please see a nurse at HIM on Davie Street or Commercial Drive for a referral.

Your visit with your care provider
Your PCP will ask you questions about your general health history, sexual health, partners, and practices in order to assess whether PrEP would be necessary, safe and effective for you. They will also require blood and urine tests checking for HIV, syphilis, hepatitis B & C, gonorrhea & chlamydia, and the health of your liver and kidneys. Some PCPs will not write the prescription until after they have received all these results, while others may write the prescription at the first visit and ask that you not start the medication until they direct you to, after the results are in. Be open and honest with your PCP about your plan to import generic medication.

Your prescription
Ask your PCP to not write the prescription for the brand name “Truvada”. Instead, ask him/her to write it for the generic “emtricitabine/ tenofovir 200/300mg” because the medication won’t have the brand name on the bottle. This reduces chance of hassle at the border, as your prescription will match the bottles exactly.

The BC Guidelines recommend a first prescription of 30 days, however, due to logistical issues of importing medications, ask your PCP to write the prescription for 90 days/ tablets. This is the maximum legal quantity of medication to import to Canada for personal use. Also, the prescription must show your PCP’s name, address, and registration number.

 

Step Two: Getting a Mailbox in Point Roberts, WA, USA

Register for a Point Roberts mailbox at InOut Parcel.
Go to https://inoutparcel.com/register/ and enter your username, email and name. Registration is free, but the cost of receiving is $3.75 USD per package. When you register, you will be assigned a Customer ID number that you will include as a part of your shipping address when ordering the medication.

Step Three: Order Medication Online 

There are three reputable online suppliers of PrEP for which this website provides comprehensive guides. Dynamix International was originally the only supplier of PrEP that DavieBuyersClub.com guided its participants to use. The addition of other options was not done because of anything Dynamix did or did not do; their provision of this important service has been (and continues to be) exceptional. However, DBC feels that including the low price-point option of Freedom Health may make PrEP accessible to even more people who need it. This is the rationale for this expansion/inclusion.

Suppliers vary in terms of cost, payment method, shipping method, etc. Please examine the summary table below and the accompanying guides to determine which supplier is right for you.

 dynamix_header_logo  FreedomHealthlogo  ADClogo
Total cost in CAD for 90 tablets (including shipping and fees) $195 CAD $115 CAD $280 CAD
Monthly cost in CAD $65 CAD/month $38 CAD/month $93 CAD/month
Shipping method EMS EMS EMS
Payment method Credit card Bitcoin Wire transfer, bank draft
Ships from country Thailand or India India India
Usual time to delivery 8-14 days 10-30 days 10-14 days
Medication manufacturer Mylan or Cipla Cipla Cipla
Medication emtricitabine/ tenofovir 200/300mg emtricitabine/ tenofovir 200/300mg emtricitabine/ tenofovir 200/300mg
Name on bottle RICOVIR-EM or TENVIR-EM TENVIR-EM TENVIR-EM
US FDA approved Yes Yes Yes
Recommendation on IwantPrEPnow.co.uk Yes No Yes
Recommendation on PAN.org.au Yes Yes Yes
Inquiries via: Email Facebook Email/ live chat Email ticket/ phone

Click here for the guide to ordering via Dynamix International

Click here for the guide to ordering via Freedom Health

Click here for the guide to ordering via All Day Chemist


2017-Feb-08 Update: click here if you are a visitor to Canada (NOT a citizen or a permanent resident). You may be able to ship PrEP directly to your Canadian home address using Dynamix.


 

Step Four: Pick Up Your Order and Return to Canada

InOut Parcel will email you when your package has arrived and is ready to be picked up.

Make sure you bring with you:
-your valid passport
-your prescription for tenofovir/emtricitabine 200/300mg x 90 days/tablets
-a print-out of your invoice from the online pharmacy, showing its price in US or Canadian dollars (the is the value of the goods you are importing, which is sometimes requested by the CBSA border agent)
-recommended: a printed or saved copy of any info you require: directions, customer ID number for InOut Parcel, or any other instructions. Once you are in the USA, your phone will switch to roaming mode which will make cellular data either unavailable or extremely expensive to look these things up.

Drive to 145 Tyee Drive, Point Roberts 
It takes about 45 minutes to drive there from downtown Vancouver, without traffic. The border wait can be anywhere between 5 and 45 minutes; weekends are typically worse than weekdays. You can check the current border wait-times here.

What if I don’t have a car, a license, or someone who can drive me?
You can take public transit! From downtown Vancouver, it takes roughly 1hr15min each way, which includes the 7min walk from the bus stop, across the border, to InOut Parcel. It is a 2-zone fare (weekdays) so the cost for a round trip is $8 cash or $6.30 on Compass stored value. Click here for the transit itinerary.

At the border
Present your passport to the USA border agent. They will ask you the reason for your visit; you can tell them you’re visiting to pick up a package.

Click here for instructions on how to actually receive your package from InOut Parcel
On your first visit, you will have to see a customer service person, fill out a form and provide credit card payment. On subsequent visits, you can just pick up from your locker 24 hours per day, 7 days per week. For your first visit though, make sure you attend during their staffed hours: Mon – Fri 9am – 5:30pm, Sat – Sun 9am – 3pm.

Returning to Canada
The Canada Border Services agent will ask the reason for your trip and if you have anything to declare. Declare that you have a 90-day supply of medication for personal use, as prescribed by your doctor/nurse practitioner. If requested by the agent, present the paper prescription and medication. If the agent asks you questions about the medication or why it was sent to the USA, answer truthfully that it is a preventative medication that is not covered and not accessible to you in Canada. As per the Government of Canada website, you are not breaking any laws and you will not likely be further scrutinized.

You’re home!
Now that you have the medication, check in with your doctor or nurse practitioner, if they requested that you wait for their ‘okay’ before initiating PrEP. Again, it is of critical importance to ensure that you have an up-to-date negative HIV test as close as possible to initiation of PrEP — it is sometimes even necessary to delay PrEP initiation to wait-out the ‘window period’ if there was a  recent possible high-risk exposure and/or flu-like symptoms to rule out acute HIV infection.

Next steps

  • Remember that PrEP is most effective when taken exactly as prescribed. Do not miss doses — seting an alarm/reminder on your phone is helpful for many people
  • The amount of time it takes to reach maximum protection is unknown, but research shows that drug concentration in the rectal mucous membrane reaches its steady state 7 days after initiating the medication. For for women and trans guys, it takes about 21 days to reach maximum drug concentration in the vagina/ front hole
  • See your doctor or nurse practitioner at least every three months to do tests for HIV, syphilis, chlamydia & gonorrhea, and to check the health of your kidneys
  • Because of the time it takes to import generic medication from abroad, get a new prescription and refill it online using the steps above when you have one month remaining (to ensure you do not run out!)

Please use the comments section below to describe your experience: success stories, hiccups, tips, questions or other feedback. These can also be emailed to daviebuyersclub@gmail.com

23 thoughts on “How to Access PrEP Without Insurance in Vancouver (for $65 CAD Per Month)”

  1. Would you allow republication of this process with specific instructions for other locations in Canada, specifically Winnipeg. Our local Gay Men’s Clinic is interested I having this type of information available to its clients if it was more applicable to the Winnipeg area.

    Like

    1. Hi Alan, thanks for your inquiry. Of course, I am happy for this information to be shared and reproduced. I would also be interested in expanding this website to include other Canadian cities — if you would like to include Winnipeg-specific details (such as how to find a family doctor, the address of your Gay Men’s Health Centre, and a suggested parcel-receiving company in the US near the border) that would be helpful. Please let me know what you think. Thanks

      Like

  2. Hi, I just got my order from Green Cross refunded as their orders to the US have been returned by customs. Is there another option that you know of? I had heard of one from the US that required a money order for payment. How reliable are they?

    Like

    1. Hi Trevor, I just heard this morning that many orders were refunded because of customs refusal. I will be revising my website to temporarily use https://www.alldaychemist.com/tenvir-em-300-200mg.html which is reliable, but unfortunately is about 50% more expensive (as it is in USD and then requires 25USD for shipping and 30-40$ CAD fee for a money order). Stay tuned for a guide, or proceed on your own immediately if you feel comfortable doing so.

      Like

  3. If I order now by using Dynamix International, will the package be refused by US custom? I have my own Postal Box in Lynden Washington. Will the order be delivered to my PO box (no signature required by Fedex?)?

    Like

    1. Hi Roger,
      Dynamix Internation uses FedEx to ship and they, unlike DHL, are able to correctly navigate the importation process. I do not forsee any shipments that follow Dynamix’s instructions being rejected by US Customs.

      The second point you raised is about PO boxes: do not ship to a PO box! The package needs to be signed for. This is why my site guides people you use a parcel service. You may use any parcel service, not just the one I described. You may also ship to a friend or relative.

      Please let me know if you have any other questions.

      Like

  4. Hello. Is it possible for persons other than the one named in the prescription to pick up the medication in the US and bring it into Canada? Can I pick up the medication for myself and my partner, for example? Or even have the meds couriered from the US to me, by having the US address enclose the prescription?

    Like

    1. Hi Charles,
      I’m sorry to say that both of these methods are NOT permitted by Canada Border Services Agency as a legal way to import medicine. If someone chose to do so anyway, it would be at their own risk.

      Like

  5. Hello, I am very interest in using this process to get the generic Truvada, but I am an international student living in canada, is that something that might be detrimental of my crossing the border from two countries without having the passport of either one?

    Thanks,

    Like

    1. Hi Peter,
      I have not heard of the recent change of American federal government adversely affecting any Canadians crossing the border to pick up their prescriptions. Trump’s executive order to block entry to the USA for citizens of those seven Muslim-majority nations was also struck down by the courts, and is no longer in effect. You may reach a broader audience about their experiences by asking in PrEP Canada Facebook group https://www.facebook.com/groups/prepcanada/

      Like

  6. I just got my pills 10 minutes ago. I’m from Vancouver Canada and I picked them up in Point Roberts. I had no trouble going down informing the agent I was picking up medication from the Parcel Service. On the way back the border agent had me go inside because he had never encountered my situation. Inside I waited maybe 10 minutes. When it was my turn to go to the desk the Canadian border agent seemed familiar with my situation, looked over my documentation as Daviebuyersclub.com informed me I should have all documents and let me through. Yay easy breezy. Thanx Daviebuyersclub

    Like

      1. Thanks so much for all the info! Was helpful in getting everything set up with my Dr, ordering and delivery. Like Deej, was super easy to pickup with no issues at the Border. Only took 7 days from ordering to pickup in Pt. Roberts.

        Liked by 1 person

  7. Hi, I’ve been trying to contact the pharmacy to confirm that I’m eligible to ship the product directly to Canada (I’m a visitor and have all the documents in place), but I have not heard from them for more than a week. Do you think it’s safe to place the order anyway or should I just wait to hear back from them? I was hoping to get started soon. Did anybody else successfully ship it to their home address in Canada with no issues?

    Like

    1. Hi there,

      I’m sorry to hear you’ve had a hard time getting confirmation from the pharmacy about shipping directly to Canada as a visitor. I think it’s worth going through the process and uploading all your documents and generating an order number — but I would advice against making the payment until you hear from the pharmacy. I’m sure they get a TON of email — you may get a quicker response by reaching out on their Facebook page https://www.facebook.com/groups/1632601210338569/ and you can cite the order number that you’ve created.

      There is at least one other report of a visitor successfully completing this process: it was posted here https://www.facebook.com/groups/prepcanada/permalink/981534891948287/

      Please keep me posted about how it goes. Best wishes

      Like

      1. Thank you for your reply. But actually at the moment the purchase-prep.com website does not seem to work at all. If you click the order link in step 3, there is an error… as if the website doesn’t exist anymore?! “Looks Like This Domain Isn’t
        Connected To A Website Yet!”. Tried on multiple browsers and connections. I’m pretty sure it was fine until recently. Maybe it’s a temporary problem or is that pharmacy no longer an option?

        Like

  8. I ordered from 90 days of Generic PreP (Tenvir EM (Truvada)) on July 24, 2017, from Freedom Health though their online pharmacy based in Switzerland. The drug is manufactured in India and sent directly from there to the USA. I received confirmation on July 26th that the package had been sent and a tracking number.

    As of August 15th (today) the package is still awaiting US Customs clearance at San Francisco after arriving there on Aug. 5th so I think it is important to plan on a possible 1-2 week waiting time for customs alone.
    The other thing that should be mentioned is that Freedom Health was only accepting “Bitcoin” as payment for the medication so I had to set up a “Coinbase” account to convert Canadian funds into Bitcoin before I could purchase the medication.

    It was the very first time that I had ever used Bitcoin and I have to say I was not thrilled with this form of payment since Bitcoin Valuation can bequite volatile and fluctuate in value quite a bit even daily. If it wasn’t for the MUCH cheaper cost for the PreP from Freedom Health, I would have probably gone with one of the other online pharmacies.

    I will follow up with this post once I have (hopefully) received the package at my mailbox in Point Roberts, WA, and have been able to return with the PreP through Canadian Customs.

    P.S. I don’t have a car so I have to do the long trek by bus to the US. If anybody has a car and want me to help cover the cost of the gas or even pay for it to go to get the PreP together, maybe the Davie Buyers Club could arrange a blog or message board to share contact info?

    Like

    1. Hi Sean,

      Thanks for your feedback. I have recently updated my website to represent/warn regarding the longer ETA of shipments that may be delayed in US customs, occasionally up to 30 days.
      I agree that bitcoin is not highly user-friendly, and that its value is volatile. I recommend completing the purchase immediately after purchasing the bitcoin to avoid problems with it changing value before you’re done. Hopefully FH will be able to receive credit card payments in the future.

      As for carpooling to the border, I’m not currently in a position to facilitate this but perhaps you could reach out on the FB group https://www.facebook.com/groups/prepcanada/ or contact the Health Initiative for Men http://checkhimout.ca/about/contact-us/

      Keep in mind that taking the bus in some instances may actually be faster: I have at times waited over 45 minutes to cross the border by car, while pedestrian crossers bypass the line and walk right up to the agent’s window.

      Cheers,
      DBC

      Like

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