“California is once again leading the way by working to increase access to life-saving HIV prevention medication."
Late last month, Senator Scott Wiener (D-San Francisco) and Assemblymember Todd Gloria’s (D-San Diego) legislation to reduce barriers to accessing HIV preventative medications passed the Senate on a vote of 34-1. It now heads to the Assembly for committee hearings in the coming weeks. SB 159 authorizes pharmacists to furnish pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to patients without a physician prescription. (Pharmacists are already authorized to furnish emergency contraceptives and the birth control pill without a prescription.) The legislation also prohibits insurance companies from requiring patients to obtain prior authorization before using their insurance benefits to obtain PrEP or PEP.
Both provisions will expand access to PrEP and PEP by increasing the places where people can access these medications, increasing the number of healthcare professionals who can provide it, and removing onerous and unnecessary insurance barriers.
PrEP is a once-daily pill for HIV-negative people that almost entirely eliminates the risk of contracting HIV. PEP, on the other hand, is medication that a person takes after being exposed to HIV, in order to prevent the virus from taking hold. PEP is a 28-day course of drugs that, if started within 72 hours after exposure to HIV, significantly reduces risk of infection. Both PrEP and PEP are critical strategies to prevent new HIV infections and to ultimately end the epidemic. Yet, PrEP uptake, in particular, has been slow and especially so among communities of color.
In 2014, Senator Wiener publicly disclosed that he takes PrEP as an HIV prevention strategy. He did so in order to increase awareness of this important HIV preventative and to reduce the stigma around discussing sexual health.
“By allowing pharmacists to furnish these revolutionary medications, we will help reduce HIV infection rates and create a stronger path toward ending new HIV infections entirely,” said Senator Wiener. “We must reduce barriers to life-saving drugs like PrEP and PEP, and today’s vote means we are one step closer to doing just that. We have the tools to end new HIV infections, and we can get there in our lifetime.”
For years, medical and public health professionals, as well as HIV advocates, have demonstrated the efficacy of PrEP and PEP in dramatically reducing the transmission of HIV. A 2011 study of gay men and transgender women, found that drug levels corresponding to daily use of PrEP are associated with 99% protection against HIV. The more individuals who are able to access these medicines, the fewer new HIV infections we will see throughout California.
The California Department of Public Health, Office of AIDS (OA) estimates there are 220,000 to 240,000 Californians with an indication for PrEP, but data suggest that only 9,000 people were taking PrEP in late 2016. Additionally, a recent report found that while new HIV infections have decreased, we still see a large disparity between black and Latino gay men and their white counterparts. Latino men were almost twice as likely to contract HIV as white men, and black men were over 3 times as likely. Increasing access to PrEP and PEP is particularly important to reduce new HIV infections in communities of color.
“California is once again leading the way by working to increase access to life-saving HIV prevention medication,” said Equality California Executive Director Rick Zbur. “If ending the HIV epidemic is a ‘moon shot,’ then we’re halfway there, the science is clear and we have plenty of fuel in the tank. We know how to get this done, and the bipartisan group of senators who supported SB 159 just put us one step closer to zero — zero new transmissions, zero HIV-related deaths and zero stigma against people living with HIV.”
Despite their effectiveness, several barriers limit access to PrEP and PEP. These barriers include stigma, medical mistrust and judgment by some healthcare professionals, high costs for patients, scarcity of facilities, challenges getting appointments with physicians, burdensome prior authorization requirements, and an insufficient number of providers who are comfortable prescribing PrEP and PEP. Although some local health departments have implemented programs to increase access to PrEP and PEP, many parts of the state do not have sufficient resources to effectively reach all those who could benefit from these interventions.
Further, several California health plans now require documentation to request prior authorization every three months for PrEP. The three-month cycle for prior authorizations puts patients at risk of delays and medication interruptions – thus increasing the risk of HIV infection – and creates unnecessary burden to providers.
“APLA Health applauds the Senate for taking bold action to improve access to PrEP and PEP, which remain out of reach for far too many Californians,” said Craig E. Thompson, CEO of APLA Health. “SB 159 is the first legislation of its kind in the nation and an important step toward increasing use of these life-saving medications.”
“The low rates of PrEP and PEP use across California signal the need to offer these effective prevention tools in additional ways,” said Joe Hollendoner, CEO of the San Francisco AIDS Foundation. “This bill removes unnecessary barriers and streamlines access to PrEP and PEP, so anyone who needs preventative measures can get it. We applaud the California Senate for voting to move SB 159 forward and we are thankful to Senator Wiener for his leadership. We look forward to continuing to work together toward ending new HIV transmissions.”
Allowing pharmacists to furnish these medications will increase the number of individuals who choose to take PrEP or PEP. Pharmacists are qualified to discuss the importance of this medication with their patients. Because PrEP and PEP both require strict adherence to a regimen, pharmacists are able to ensure patients stick to the medical requirements. Due to PEP’s time sensitivity, removing the pre-authorization requirement is especially important to guarantee that people can get the medicine within the first 72 hours post exposure.
PrEP and PEP are covered by most private insurance programs, as well as by Medicare, Medi-Cal, and Covered California health plans.
SB 159 is co-sponsored by the San Francisco AIDS Foundation, APLA Health, the Los Angeles LGBT Center, Equality California, and the California Pharmacists Association. SB 159 is also co-authored by Senators Steven Glazer (D-Orinda) and Jeffrey Stone (R-La Quinta), and Assemblymembers Mike Gipson (D-Carson) and David Chiu (D-San Francisco).
For full text of the bill, please click here.