New PrEP Guidelines: What You Need to Know
Updated clinical guidelines expand PrEP eligibility and simplify prescribing for healthcare providers.
Updated clinical guidelines expand PrEP eligibility and simplify prescribing for healthcare providers.
Pre-exposure prophylaxis (PrEP) has been one of the most significant advances in HIV prevention since the development of antiretroviral therapy. Since the FDA approved the first PrEP medication (Truvada) in 2012, PrEP has transformed HIV prevention — but uptake has remained uneven, and barriers to access persist. In early 2026, updated clinical guidelines from the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) are reshaping how clinicians identify, counsel, and prescribe PrEP.
The updated PrEP guidelines reflect a significant shift in approach: moving from a risk-factor-based model to a broader, more inclusive framework that reduces barriers to PrEP access. Key changes include:
The new guidelines broaden PrEP eligibility beyond specific risk categories. Rather than requiring clinicians to identify patients with specific risk factors, the updated framework encourages discussing PrEP with any sexually active adult who wants to reduce their HIV risk. This approach reduces the stigma associated with being identified as 'high risk' and increases the number of people who can benefit from PrEP.
The updated guidelines streamline the baseline evaluation required before starting PrEP. While HIV testing, kidney function assessment, and STI screening remain important, the guidelines clarify that not all tests need to be completed before the first prescription is written. This 'start now, test later' approach can reduce delays in initiating PrEP.
The updated guidelines formally incorporate cabotegravir (Apretude) — the long-acting injectable PrEP approved by the FDA in 2021 — as a preferred option for eligible patients. Given as an injection every two months (after two initial monthly injections), cabotegravir eliminates the need for daily pills and may be preferable for people who have difficulty with daily adherence.
The guidelines clarify that PrEP is appropriate for adolescents at risk for HIV, and address the legal and practical considerations for prescribing PrEP to minors. In many states, adolescents can consent to PrEP without parental involvement.
As of 2026, there are three FDA-approved PrEP options in the United States, each with distinct characteristics:
| Medication | Dosing | Efficacy | Best For |
|---|---|---|---|
| Truvada® (TDF/FTC) | Daily oral pill | ~99% (sex), ~74% (injection) | Adults; generic available |
| Descovy® (TAF/FTC) | Daily oral pill | ~99% (sex) | Adults with kidney/bone concerns; not for receptive vaginal sex |
| Apretude® (CAB-LA) | Injection every 2 months | >99% (sex) | People who prefer injections over daily pills |
Despite PrEP's proven effectiveness, significant disparities in PrEP use persist. CDC data shows that while Black and Hispanic individuals account for the majority of new HIV diagnoses, they represent a disproportionately small share of PrEP users. In 2023, white individuals accounted for approximately 66% of PrEP users, despite representing only about 26% of new HIV diagnoses.
The updated guidelines address these disparities by emphasizing the importance of proactive PrEP discussions with all patients, particularly those from communities disproportionately affected by HIV. The guidelines also highlight the role of community health workers, pharmacists, and telehealth in expanding PrEP access to underserved communities.
The Ending the HIV Epidemic initiative has set a goal of increasing PrEP coverage to at least 50% of people who could benefit from it. Achieving this goal will require not only updated guidelines but also sustained investment in outreach, education, and structural interventions to address the social determinants that limit PrEP access.
Cost has been a significant barrier to PrEP access. The updated guidelines emphasize that, under the Affordable Care Act (ACA), most insurance plans are required to cover PrEP with no out-of-pocket costs, following a 2019 USPSTF recommendation. This includes the cost of the medication, required lab tests, and clinical visits.
For uninsured individuals, State PrEP Assistance Programs provide PrEP at no cost to eligible individuals. Gilead Sciences also offers the Advancing Access program for co-pay assistance for Truvada and Descovy. For cabotegravir (Apretude), ViiV Healthcare offers the ViiV Connect patient assistance program.
If you are sexually active and want to reduce your risk of HIV, the updated guidelines make it easier than ever to access PrEP. Here's what you should know:
To find a PrEP provider near you, use the PrEP Locator or the HIV.gov service locator.
For healthcare providers, the updated guidelines represent an opportunity to expand PrEP prescribing and help close the gap between need and use. Key recommendations for providers include:
For clinical consultation on PrEP prescribing, contact the National Clinician Consultation Center (NCCC) at 1-855-448-7737 (free, confidential).