Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) Temporary Coverage
CLIENT ATTESTATION AND CONSENT
The Pre-Exposure Prophylaxis (PrEP) Assistance Program is a subsidy program administered by the California Department of Public Health (CDPH) to subsidize certain costs of medication for the prevention of HIV infection and other related medical services for eligible individuals. Eligible individuals may enroll in PrEP-AP Temporary Coverage through contracted pharmacies in the Magellan network. PrEP-AP Temporary Coverage provides limited and temporary coverage of PrEP, post-exposure prophylaxis, and HIV testing. Individuals applying for PrEP-AP Temporary Coverage must meet eligibility standards. Services are only available to persons who are uninsured and are HIV-negative.
As you enroll in PrEP-AP Temporary Coverage through a contracted pharmacy, you will be required to read and sign legal forms acknowledging your consent to participate and attesting that you will provide true and accurate information.
The pharmacy may direct you to this site to sign read and sign these forms electronically. You may also sign these forms before proceeding to the pharmacy. You will be redirected to DocuSign where you can read and sign the legal forms. Once you complete signing, you will return to this site and will receive a confirmation code. Please provide this confirmation code to the pharmacy while you apply.
Please fill out your information below to begin the process.