Germany made PrEP history in 2019: it became one of the first countries to make PrEP fully free on statutory health insurance (GKV), with no copayment for the medication itself. If you have GKV, Germany is one of the best places in the world to access PrEP. Here's exactly how the system works.

The Short Version

  • GKV (statutory insurance): PrEP medication is free. You pay the standard €10/quarter specialist visit fee (Praxisgebühr equivalent) and nothing for the drug.
  • PKV (private insurance): Coverage varies by policy; some cover PrEP, many do not. Privatrezept possible but costs €50–100+/month.
  • No insurance / EU visitors: Privatrezept route; some clinics offer sliding scale.
  • Prescribing doctor: Must be a Schwerpunktarzt — a specialist in HIV medicine.

Step 1: Find a Schwerpunktarzt

A Schwerpunktarzt (HIV specialist doctor) is the only type of doctor authorised to prescribe PrEP on GKV in Germany. GPs cannot prescribe PrEP directly.

Find one at: dagnä.de — the national directory of HIV-specialised practices.

Search by city or postcode. Filter for PrEP-Begleitprogramm (PrEP accompanying programme) if available in the filter.

Major Schwerpunktpraxen:

  • Berlin: ICH (Infektionscentrum Hamburg? — no, ICH Berlin: Dresdener Str. 91), Praxis am Checkpoint, Praxis Jessen Jessen Heitmann (Motzstr. 19)
  • Hamburg: ifi-Institut, Praxis Dr. Schewe (Glockengießerwall 1)
  • Cologne: Praxis am Ebertplatz, Gemeinschaftspraxis Kurfürstenstraße
  • Munich: MVZ Karlsplatz, Schwerpunktpraxis München
  • Frankfurt: Praxis Rodel/Stern

In large cities, Schwerpunktpraxen have long waiting lists — sometimes 3–6 months. See below for how to handle this.

Step 2: Get a Referral (Überweisung)

To see a Schwerpunktarzt on GKV without paying privately, you need an Überweisung (referral) from your Hausarzt (GP). This is a simple form your GP fills out — they don't need to know much about PrEP, they just refer you.

Say to your GP:

"Ich möchte eine Überweisung zum Schwerpunktarzt für HIV-Medizin, da ich PrEP beantragen möchte." ("I'd like a referral to an HIV specialist, as I want to apply for PrEP.")

The referral is quartalsgebunden — it's valid only within the same calendar quarter (Jan–Mar, Apr–Jun, Jul–Sep, Oct–Dec). If you get a referral in late March, make your appointment before 31 March or request a new one in April.

Step 3: The Aufnahmestopp Problem (and Workarounds)

Many top Schwerpunktpraxen in Germany have an Aufnahmestopp — they're not accepting new patients. This is the single biggest barrier to PrEP in Germany.

Workarounds:

  1. Call early in the quarter — some practices release a small batch of new patient slots at the start of each quarter (1 January, 1 April, 1 July, 1 October). Call on the opening day.
  2. Ask to be put on the waiting list — confirm you're on it and check in periodically.
  3. Try adjacent cities — if Berlin is full, try Brandenburg. If Hamburg is full, try Lübeck.
  4. Community Checkpoint referrals — Checkpoint BLN and similar centres sometimes have fast-track referral pathways to partner practices.
  5. Private bridge prescription — if you're urgently at risk and can't get an appointment, some Schwerpunktärzte will see you privately (Privatrezept) for an initial appointment and then transfer you to GKV once you're registered. This typically costs €80–150 for the first consultation and €50–100/month for medication on Privatrezept.

Step 4: The PrEP-Begleitprogramm

Once registered with a Schwerpunktarzt for PrEP, you enter the PrEP-Begleitprogramm — the mandatory accompanying programme. Every three months you must attend for:

  • HIV test (4th-generation antigen/antibody)
  • STI checks (syphilis, gonorrhoea, chlamydia — ideally three-site)
  • Hepatitis B/C check (periodically)
  • Kidney function blood test (creatinine) — tenofovir can affect kidneys
  • Prescription renewal

Missing an appointment means your prescription lapses. Set calendar reminders.

Medication

Germany prescribes generic tenofovir disoproxil fumarate / emtricitabine (TDF/FTC) — the same active ingredients as Truvada, but substantially cheaper. Brand-name Truvada is no longer used for PrEP on GKV.

Dosing options discussed with your Schwerpunktarzt:

  • Daily PrEP: One tablet every day, consistent protection level.
  • Event-based (2-1-1): Two tablets 2–24 hours before sex, one 24 hours later, one 48 hours later. Only recommended for anal sex with men; not recommended if you also have receptive vaginal sex or hepatitis B.

Ask your Schwerpunktarzt which suits your lifestyle.

Costs Summary

Situation Medication cost Appointment cost
GKV insured €0 ~€10/quarter co-pay for specialist visit
PKV (covers PrEP) €0 or partial Depends on policy
PKV (doesn't cover) / Privatrezept €50–100/month €80–150/visit
Uninsured / visitor €50–100/month €80–150/visit

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