PEP (Post-Exposure Prophylaxis) must be started within 72 hours of a high-risk HIV exposure. The clock starts at the moment of exposure—not when the clinic opens. Massachusetts has 24/7 access points, and the ER is your fallback at any hour.
🚨 Where to Go Right Now
| Time / Situation | Where to Go | What to Expect |
|---|---|---|
| Weekday daytime (Boston) | Fenway Health Urgent Care | Call (617) 927-6400. Fastest specialist route. Can start same-day. |
| Weekday daytime (statewide) | Your nearest FQHC or sexual health clinic | Call ahead to confirm PEP is available. |
| Evening / Weekend / Any time | Nearest hospital Emergency Room | EMTALA ensures assessment regardless of insurance. Say "I need PEP for HIV exposure." |
| Remote / telehealth bridge | PlushCare or MISTR | Emergency telehealth PEP consultation available 24/7 in some cases. |
Do not wait for a convenient time. Every hour reduces PEP's effectiveness. The ideal window is within 24 hours; the absolute legal maximum is 72 hours.
🗣️ What to Say at the ER
Massachusetts hospital ERs (Mass General, Brigham and Women's, BIDMC, etc.) have clinical protocols for PEP. Use precise language to be triaged appropriately.
- "I've had a potential HIV exposure and I need Post-Exposure Prophylaxis — PEP."
- State the timeline: "The exposure was [X] hours ago."
- Describe the specific exposure clearly: receptive anal sex, condom failure, unknown partner status. The clinician needs these facts to prescribe correctly.
The Starter Pack: ERs typically provide a 3-to-5-day bridge supply. You must follow up at Fenway Health or your FQHC the next business day to receive the full 28-day course and baseline bloodwork.
💊 The Medication & What to Expect
Standard Massachusetts PEP regimen: Truvada (TDF/FTC) + dolutegravir (Tivicay) or the combined tablet Dovato.
- PEP is a strict 28-day daily regimen. Missing doses compromises effectiveness.
- Side effects (nausea, fatigue, diarrhea) are most intense in week 1. Your prescriber can provide anti-nausea medication.
PEP is not a single pill. It is a 28-day commitment. Starting it and stopping early is worse than not starting it at all—it can drive drug-resistant HIV mutations if you were infected.
💲 Cost & Coverage
| Route | Cost |
|---|---|
| MassHealth | Free |
| ACA/Private Insurance | Covered; may have copay. Gilead offers a co-pay card. |
| Uninsured (ER) | EMTALA law requires emergency care. Billing is resolved after. Do not delay over cost. |
| Gilead Advancing Access | Free PEP medication for uninsured patients who meet income requirements |
📅 After PEP: The Follow-Up Protocol
After completing the 28-day course, return for confirmatory HIV testing:
- At 45 days post-exposure
- At 90 days post-exposure (definitive)
Fenway Health has a dedicated PEP follow-up clinic. When they give you the starter pack at the ER, they will typically book your Fenway follow-up appointment at the same time.
After PEP, talk to your provider about starting PrEP to prevent needing PEP again.
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