Since the end of 2017, there are two PrEP generics (emtricitabin/ tenofovir [disoproxil fumarate] – better known as Truvada®) available in Germany:
The Hexal®-PrEP is also known as blister PrEP, as it is dispensed in a special blister pack and costs around 40EUR/28 pills. The ratiopharm®-PrEP costs around 70EUR/30 pills. The original product Truvada® by Gilead is far too expensive (about 800EUR). The company Aliud Pharma® reduced the price for their Emtricitabin/Tenofovirdisoproxil-AL to 70EUR/30pills – yet they do only have the approval for HIV-therapy but it works as well as PrEP.
Update early 2019: ‘Duomevolen’ by Amneal (ca 50 EUR) and ‘Emtenovo’ by TAD Pharma (ca 60EUR/35 tablets) are available in all german pharmacies beside the Ratiopharm product.
You will need a prescription in order to obtain PrEP medications at street pharmacies in Germany or at online pharmacies located in Germany. As far as we know, the Hexal®-PrEP is only available for persons living in Germany and holding health insurance (even though the costs are not paid by it). That is because this medicine is available only within a special program, reserved for selected doctors and pharmacies.
The PrEP of ratiopharm®, which is slightly more expensive, is available for anyone with a private prescription. The exact name of the medication is
200 mg/245 mg Filmtabletten
and it is available in every pharmacy. The same applies to the product of Aliud Pharma® and other companies may follow soon with maybe cheaper prices. Ask for it!
Usually the medicine is not immediately available in the pharmacy. You may have to wait for a few hours or until the next day to have it delivered to the local pharmacy. That means:
IF YOU ARE IN GERMANY
… you can get PrEP regardless of your residence permit status and your health insurance status. The ratiopharm®-PrEP (or the Aliud® product) is available for tourists, whether short- or long-term visitors, guest students, sans papiers (undocumented migrants), people who travel through Germany (EU or non-EU citizens) and who can afford consultation, prescription of (any) doctor in Germany and the price for the medication.
If you are an EU citizen and staying in Germany it is possible to bring a prescription from your home country or another EU country. The pharmacies in Germany will accept this, due to the rules of the European single market.
How much PrEP medication you can bring into the country of your destination depends on its specific import regulations. Please inform yourself about those regulations before you buy PrEP medication here (e.g. you might ask customs at the airports of your home country when leaving for your trip or call them anonymously from abroad).
FROM AN EU COUNTRY
Due to the EU law concerning prescriptions (German translation here), pharmacies must accept any prescriptions issued by any doctor from any country within the EU. The medicine for PrEP has been authorized all over EU in 2016. Doctors from any EU country are authorized to issue this prescription. As said before, the prescription has to show the correct product name (see above).
You may order PrEP medication online if you (or someone else) are not planning to travel to Germany. In Germany it is perfectly legal to buy medicine from an online pharmacy based in Germany. You can have it delivered to EU addresses depending on the customs regulations of that EU country. Usually one up to three monthly packs for personal use only are permitted. Check the customs regulations before your order.
Online order can be placed also for medication which require a prescription, e.g. the medication used for PrEP. Online pharmacies require to have the original copy of the prescription sent to their address before completing the order. In addition to German and EU laws concerning the pharmaceutical and consumer protection, they have to consider the regulations of the pharmaceutical legal situation in your country. This could take one or two days to double-check the legal situation in your country.
Your order will be delivered within 3-10 working days. The delivery costs around 20EUR, however several pharmacies offer free delivery if the price of your purchase exceeds a specific amount.
Unfortunately the websites of the online pharmacies do not always have an English translation and it can be difficult to compare the service. Therefore you may need some help of a German speaking person to manage the order process. Please note that the right to deliver PrEP to EU countries does not mean that every provider is offering this service.
To make everything more complicated: online pharmacies from other EU countries might offer PrEP as well so it is worth to check!
Here some (German, EU) online pharmacies who are offering PrEP delivery to EU countries: www.eurapon.de, www.versandapo.de (en), www.shop-apotheke.com, www.mycare.de (en), www.docmorris.de, www.medikamente-per-klick.de, www.besamex.de, www.medpex.de, www.aponeo.de, www.lysano.de, www.bodfeld-apotheke.de (en), www.delmed.de, www.elisana.de, www.fliegende-pillen.de, www.pharmeo.de (example links of our internet research, search item: “Emtricitabin/Tenofovirdisoproxil-ratiopharm”, as of Jan 2018. Those companies are only examples. Love Lazers does not advertise them and we do not get paid or receive any advantages.
When it comes to Switzerland (CH), ordering at non-German online pharmacies would be cheaper in most cases. However: it is also legal to order from Germany and some people may choose to do so. Swiss law permits normally the import of one monthly pack for personal use. The good (but off-the-record) news for PrEP deliveries from all countries (EU and non-EU countries) to CH is: since recently, a three months amount is tolerated and can be obtained directly online, if you have a prescription from a Swiss doctor (while only one package is allowed if you have no prescription). The same applies if you are entering the country with medication for your personal use. This is an informal exception by Swissmedic, the Swiss agency for therapeutic products. Unfortunately, the national surveillance authority for medicines/medical devices has not officially published this nor is it an official law. It is not understandable why such an important information is not accessible to everyone. The legal situation of PrEP in CH (no approved medication, only off-label use) is embarrassing for Swissmedic. This informality as a strategy of Swiss public health has to change – immediately! An amendment and the approval of PrEP medications in CH is needed very soon.
You may still order at your own risk: one package at a time without prescription or three with a valid prescription from your (Swiss) doctor.
Furthermore, it is interesting to know that you can get ratiopharm®-PrEP by every Swiss pharmacy (e.g. if your online delivery is not arriving on time). The import of this medication is allowed because there is no other medication in CH which offers Emtricitabin/Tenofovir free of lactose. That’s why the order has to be personalized. It will cost about 95CHF for 30 pills and about 280CHF for 90 pills. Because the Swiss pharmacy is making the final retail price, this is more expensive than in Germany. Usually the order will be available in two, three days everywhere in CH.
FROM THE REST OF THE WORLD
First check the regulations of customs and pharmaceutical laws concerning PrEP of the country where you live/are right now. PrEP medication can be used as HIV treatment as well and may be used as evidence that you are possibly gay/hiv positive/drug user/sex worker or similar. This could be a reason to not let you enter a country if you are not a resident there and carry that medication along or it can lead to other serious consequences. As far as we know, personal use of PrEP medication is legal in most countries.
Depending on the country to which you import PrEP from Germany, it might be more expensive than the use of online pharmacies elsewhere but not necessarily. If you do so the German online pharmacies will charge you the fees for customs and delivery which can be exorbitant.
More interesting might be the possibility to bring PrEP medication in your luggage from Germany to your country. Concerning the customs and drug/pharmaceutical regulations this will be allowed for personal use only (check the permitted amount of packages before!). This means: if a friend/family member is bringing PrEP products to you, he/she might need to show a personalized prescription at customs immigration.
At certain online pharmacies (e. g. from Thailand or Swaziland) you can get a three-month pack for the equivalent of 90EUR including shipping. This is still notably cheaper than the German PrEP generics. Ordering to the UK can be done without further complication. You can bring PrEP products legally for your personal use from UK to EU countries.
Some people order generics to a residential address in the UK and have it send additionally to a German postal address through a shipment company. People that do so should know that this is not legal. However, the mailing is legal, if a private person in the UK sends it without any commercial purposes to a private address in the EU. If you have a German postal address (friends/family) it could be an additional way for you to get cheaper PrEP products.
OUR SUMMARY AND STATEMENT
If you organize PrEP yourself, you run the risk of not paying enough attention to your medical care while you are taking PrEP. German PrEP products are available only by prescription, which is essentially a good thing. Whether you live in Germany or elsewhere, you should find a doctor who is willing to advise you on PrEP in general and run a range of tests i.e. preliminary HIV testing, blood and urine tests on a regular basis (every three months) to check your kidney functions as well as your STI status (sexual transmitted diseases) alongside. This may lead to additional costs at your own expense. We think medical assistance for prep is absolutely necessary.
It is usually cheaper to order at non-German online pharmacies than getting German PrEP products. However: It is legal to order PrEP from German pharmacies and especially when you are in the country this can be a good option for you to get it fast.
Still, the German PrEP generics are far too expensive and the situation concerning PrEP accessibility here is complicated for people from abroad, specifically for non German speakers. In order to reduce HIV infections effectively here, in the EU and in a global perspective, prices have to drop and health systems (insurances, governmental funds/programs, checkpoints) have to find a way to cover PrEP costs (medication, consultation, tests). Especially for undocumented migrants and sex workers living in Germany without health insurance – PrEP should be paid by the general public.
Right now we have the (very neo-liberal) situation in Germany of building a new, profitable market of “biopharmaceutical HIV/STI prevention” with product launches by pharmaceutical companies, development of prices, patent laws, pharmacy discounts and customs regulations plus individual market players (you). Persons who are willing to protect themselves with PrEP have to act on their own risk and pay everything by themselves, others who are not able to do so live with a higher risk to get infected.
German health policy is not taking any efforts to establish a wider access to PrEP. This needs to be criticised harshly. Public health is overall social task. Make PrEP accessible to everyone who needs it!
SOME GENERAL INFORMATION
TRAVELLING WITH MEDICATION IN THE EU
Within the EU, EU citizens and people who have the right of residence are regarded as citizens of the respective country they enter to/cross border into and customs controls rarely happen (random inspections). Nevertheless, every country has its own customs regulations. Travellers are supposed to register goods themselves, usually marked as a red entrance or passageway for example at airports. For travellers who have nothing to declare are usually not taken aside by authorities when passing through the green passageway. Medication brought for personal use is usually not needed to be declared (except controlled substances/narcotics). Depending on the country’s interpretation of personal use, 1-3 months’ packages of prep medication are permitted.
If you stop for transit while travelling (i. e. for a flight stopover) in another EU country, the regulations of the country of destination will apply.
HELPFUL INFORMATION ABOUT CUSTOMS REGULATIONS EU/WORLDWIDE
For general information visit www.hivtravel.org – a website, which lists facts about worldwide customs regulations for HIV medication. Because PrEP products are used for HIV therapy as well, this overview will help a lot.
This web resource contains quick references to restrictions in English, German, Italian, Polish, Russian, French, Slovak, Spanish and Portuguese language.
© 2018 LoveLazers. We do not assume any liability for accuracy or completeness. This information does not represent any form of instruction or request to promote illegal import/acquisition/distribution of medication covered by German/EU/Swiss pharmaceutical law.
Foto: “Hot Club 1” by Murat Önen, 2016