PrEP in Germany: The Schwerpunktarzt Route

PrEP in Germany is fully covered by statutory health insurance (GKV) and straightforward once you are in the system. The catch? Getting into the system. Waitlists at specialist clinics in major cities can be months long (Aufnahmestopp), meaning you might have to bridge the gap with private prescriptions or get creative with scheduling.

Who Can Get It

If you have statutory health insurance (GKV), PrEP is a legal entitlement for anyone assessed at "substantial risk" of HIV. This explicitly includes gay and bisexual men (MSM), trans individuals, sex workers, and those with HIV-positive partners not on treatment.

• GKV (Statutory Insurance): Fully covers the doctor's appointments, lab tests, and the medication. You only pay the standard pharmacy copayment (Zuzahlung) of €5–€10 for a three-month supply.
• PKV (Private Insurance): Coverage depends entirely on your specific policy. Some cover it completely; others exclude it, leaving you to pay out of pocket.
• Uninsured / EU Visitors: You must pay privately for both the appointments and the medication.

How to Get It

Step 1: Find a Schwerpunktarzt

In Germany, PrEP is almost exclusively prescribed by a Schwerpunktarzt (HIV specialist) or a doctor certified for the PrEP-Begleitprogramm. Your standard GP (Hausarzt) generally cannot prescribe it unless they have this specific certification.

You can find a certified practice via dagnae.de — the national directory. Search your city and filter for PrEP-Begleitprogramm. Major clinics include Praxis am Checkpoint (Berlin), ICH (Hamburg), and Praxis am Ebertplatz (Cologne).

Step 2: Navigate the Waitlist

Many top clinics in major cities are temporarily closed to new patients (Aufnahmestopp) or have 3–6 month waitlists. To get a slot:

• Get an Überweisung (Referral): Ask your GP for a referral to an HIV specialist ("Ich möchte eine Überweisung zum Schwerpunktarzt für HIV-Medizin, da ich PrEP beantragen möchte."). This can sometimes help clinics prioritise you.
• Call on Quarter Days: Some clinics release new patient slots on the first day of the calendar quarter (Jan 1, Apr 1, Jul 1, Oct 1).
• Look Outside the Center: Try practices in the suburbs or neighbouring towns.

Step 3: The First Appointment

The doctor will run a baseline assessment including an HIV test, kidney function (creatinine) check, Hepatitis B screening, and a full STI screen. Once cleared, you'll get a Kassenrezept (pink prescription slip) for your first supply to take to any pharmacy.

If You Can't Wait

If you are at high risk right now and the public system waitlist is 4 months long, you have options.

The Hybrid Route (Private to Public): Some specialists will see you immediately if you pay as a private patient (Privatrezept). You will pay about €80–€150 for the consultation and lab tests, plus €50–€100 per month for the generic medication at the pharmacy. Once you are an established patient, they can often transition you onto the GKV system when a slot opens up.

Self-Sourcing Generics (Not Recommended):

German customs strictly prohibits the importation of medicinal products by mail. If you try to order generic PrEP online from outside the EU, customs will almost certainly seize it, and you may face administrative fines. Do not rely on mail-order PrEP in Germany.

Never start PrEP without an HIV test. Taking PrEP with an undiagnosed HIV infection can cause the virus to mutate and become resistant to treatment. If you do manage to source pills privately, you must get a 4th-generation HIV lab test first.

What Happens After

To keep your GKV prescription, you must participate in the PrEP-Begleitprogramm. This means visiting your Schwerpunktarzt every three months for:

• HIV test (4th-generation)
• Three-site STI screen (swabs from throat, rectum, and a urine sample) — Make sure they do all three sites, don't just pee in a cup.
• Kidney function check (creatinine)
• Hepatitis B/C checks (periodically)

At this appointment, you'll also get your next 3-month prescription. Missing these appointments means your prescription will lapse. Also, check if you need Mpox, HPV, or Hepatitis A/B vaccines — they are often available for free during these visits.

What's Available

• Daily Oral PrEP: The standard. Generic TDF/FTC (tenofovir/emtricitabine). Brand name Truvada is rarely dispensed.
• On-Demand (2-1-1): Taking pills only around the time of sex. Fully supported by European guidelines for cisgender MSM. Ask your doctor about this if you don't want to take a daily pill.
• Injectable (Apretude / Cabotegravir-LA): While approved by the EMA and authorized in Germany as of 2026, the rollout has been severely delayed. It is not yet widely accessible or routinely reimbursed by GKV.

The Routes Compared