PrEP in Bulgaria: Private Access

PrEP in Bulgaria is not reimbursed by the National Health Insurance Fund (NHIF / НЗОК), meaning the public system will not pay for it. The good news is that generic PrEP is relatively cheap at local pharmacies. Access relies entirely on private initiative and knowing which doctors are actually willing to prescribe it without judgment.

Who Can Get It

Because you are paying privately, there are no strict national eligibility criteria restricting PrEP to specific groups. Anyone who requests it and passes the medical baseline checks (HIV-negative, healthy kidneys) can get a prescription.

You will pay out of pocket for both the doctor's consultation, the lab tests, and the medication itself.

How to Get It

Do not just walk into a random GP's office and ask for PrEP. Many doctors are unfamiliar with it, and some may be unhelpful or judgmental regarding gay men's sexual health.

Step 1: The Checkpoint Route

Your best move is to contact Checkpoint Sofia (run by the Single Step Foundation). They act as a navigation hub. They will refer you to an infectious disease specialist or private GP in their network who is experienced, affirming, and knows exactly how to prescribe PrEP.

Step 2: The Baseline Tests

Before prescribing, the doctor will require:

• A 4th-generation HIV test
• A full STI screen
• Kidney function test (creatinine)
• Hepatitis B screening

You will likely need to do these at a private lab (like Ramus or Cibalab) and pay for them yourself.

Step 3: The Pharmacy

Take your prescription to a local pharmacy. Generic TDF/FTC (tenofovir/emtricitabine) costs between 60 and 120 BGN per month (€30–€60). Prices vary significantly between pharmacy chains, so it is worth shopping around for the cheapest generic.

If You Can't Wait

Since there is no public waitlist to navigate, speed is just a matter of booking a private appointment. However, some people still consider self-sourcing to save money or avoid doctors.

Self-Sourcing via Mail:

Importing pharmaceuticals into Bulgaria via mail from outside the EU is heavily restricted. Customs frequently intercepts these packages. Because local generic PrEP is relatively affordable and legally accessible, the risk of customs seizure makes online ordering a bad option.

Never start PrEP without a negative HIV test. Taking PrEP with an undetected HIV infection creates drug-resistant HIV, shutting down future treatment options. If you find a way to self-source, you still absolutely must get an HIV test and a kidney check first.

What Happens After

PrEP requires maintenance. Every three months, you need to undergo monitoring. You will have to organize and pay for this yourself via a private lab or a Checkpoint clinic.

You need:

• HIV test (4th-generation)
• Three-site STI screen (swabs from the throat, rectum, and a urine sample). You must explicitly ask for the throat and rectal swabs; many standard screens only check urine.
• Kidney function (creatinine)

Take these results back to your prescribing doctor to get your next prescription.

What's Available

• Daily Oral PrEP: The standard. Generic TDF/FTC.
• On-Demand (2-1-1): Two pills before sex, one 24h later, one 48h later. This is highly recommended if you don't have sex frequently, as it halves the cost of your private prescription. Doctors in the Checkpoint network will know this protocol.
• Injectable (Apretude): While approved across the EU, injectable PrEP is not practically accessible or funded in Bulgaria as of 2026.

The Routes Compared