For whether you need PEP, the 28-day protocol, what drugs you'll be given, and how to manage the side effects, read PEP: The Emergency Brake first. This guide covers the US-specific picture: how to get PEP fast wherever you are in the country.
PEP must start within 72 hours of exposure. Ideally within 24. Don't read this guide — go to the nearest Emergency Room now and read it later.
The Universal Access Route: Emergency Room
In every US state: go to the Emergency Room. Don't wait for a GP appointment. Don't search for a sexual health clinic. Don't call your insurance first. Go straight to the ER.
Walk in and say: "I've had a potential HIV exposure and I need PEP — Post-Exposure Prophylaxis."
That's enough. ER physicians know what PEP is. If there's any hesitation, add: "I need antiretroviral medication started immediately to prevent HIV infection after potential exposure. The clock is running."
Under federal law (EMTALA), emergency rooms must provide emergency medical screening and stabilizing treatment regardless of your insurance status or ability to pay. PEP following HIV exposure qualifies. Don't let fear of cost stop you — billing is sorted after, and assistance programmes cover most or all of it.
911 works everywhere. Call it if you need help locating the nearest ER or need assistance.
Non-ER Options During Business Hours
If the exposure happened during business hours and you're within the 72-hour window, these can sometimes be faster than an ER:
- LGBTQ+ health centers: Callen-Lorde (NYC), Fenway Health (Boston), Howard Brown Health (Chicago), Los Angeles LGBT Center, Whitman-Walker (DC), and similar centres stock PEP and can initiate it same-day. Call ahead to confirm availability.
- Sexual health / HIV clinics: Many can initiate PEP for established patients; call to confirm before going.
- Planned Parenthood: Some locations can initiate PEP; call your nearest location.
- Urgent care clinics: Variable. Many can prescribe; call to ask whether they can start PEP today.
Outside business hours or if you're unsure: go to the ER. Don't spend the clock navigating phone trees.
Cost in the United States
PEP is expensive at list price — a 28-day course of brand-name antiretrovirals can run $800–1,800 without assistance. In practice, most people pay much less or nothing:
| Situation | Likely cost |
|---|---|
| ACA/employer insurance | Covered (may require prior authorisation — ER can initiate starter pack while this is sorted) |
| Medicaid | Covered in all states; prior authorisation may apply |
| Uninsured | Gilead's Advancing Access programme covers Truvada and other ARVs; apply in the ER or immediately after |
| Ryan White ADAP | Available in all states for eligible low-income people living with or at risk of HIV |
Gilead's PEP Assistance: If you're uninsured or underinsured, call 1-800-226-2056 (Advancing Access). They can provide an emergency supply. This call can be made from the ER.
nPEP Hotline: The National Clinician Consultation Center runs a 24/7 PEP line for clinicians: 1-888-448-4911. If the ER physician is uncertain about initiating PEP, give them this number.
After PEP: What Comes Next
Once the 28-day course is complete, you'll need HIV testing at 1 month, 3 months, and (for some regimens) 6 months post-exposure. See The Testing Protocol for the full post-PEP testing timeline.
If you've needed PEP, it's worth a serious conversation about PrEP — the same protection, without the 28-day ordeal, and with far simpler logistics. See PrEP in the United States: Access & Costs.
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