The use of HIV preexposure prophylaxis (PrEP) has increased, however the magnitude and distribution of the medication costs across the healthcare system remain unknown. This retrospective cohort study estimates the total out of pocket (OOP) and third-party payments with the help of an extensive pharmacy database. The prescriptions for TDF–FTC for PrEP in the United States covers greater than ninety percent of retail pharmacy prescriptions. All the third-party, OOP, and total payments, were compared by a third-party payer. The results indicated that the annual PrEP prescriptions increased from 73,739 to 1,100,684 from 2014 to 2018. In that time span, the average total cost for 30 TDF–FTC tablets increased from $1350 to $1638. Payments for PrEP medication in the IQVIA database in 2018 summed up to $2.08 billion i.e. $1.68 billion from prescriptions for people with commercial insurance, $200 million for Medicaid, $48 million for Medicare, and $127 million for those with manufacturer’s assistance.

In conclusion, the third-party and OOP payments per 30 TDF–FTC tablets have been increasing annually. The $2.08 billion in PrEP medication payments (2018) is much lesser than the actual national costs. Such high costs attributed to the health care system may hinder PrEP expansion in the future.