SACRAMENTO, Calif. — Today, Senator Scott Wiener (D-San Francisco) and Assemblymember Todd Gloria (D-San Diego) announced new legislation to reduce barriers to accessing HIV preventative medications. Currently in intent form, which means the bill’s precise details will continue to be developed over the coming months, 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 birth control pills 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.
In 2014, Senator Wiener disclosed that he takes PrEP as an HIV prevention strategy.
“Too many people continue to become HIV-positive, and we must do everything in our power to increase access to PrEP and PEP and thus end new HIV infections,” said Senator Wiener. “By allowing pharmacists to furnish these revolutionary medicines without a prescription, we will help more people – especially low-income people and people of color – stay negative. In addition, insurance pre-authorization requirements for PrEP serve no actual purpose and create significant barriers to access the medication. We know what it takes to prevent HIV, and we know that PrEP and PEP are key prevention strategies. We need do everything in our power to remove unnecessary barriers to access.”
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 trans 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 all communities.
“While many still do not know about PrEP, its ability to prevent HIV transmission has been well proven,” said Assemblymember Gloria. “It is imperative that we reduce barriers and increase accessibility to this live-saving medication. Not only can we save lives with PrEP, but we also have a real chance to eradicate HIV for good.”
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.
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.
“There should be nothing blocking people from tools that prevent HIV infection,” said Joe Hollendoner, CEO of the San Francisco AIDS Foundation. “Streamlined PrEP and PEP access must be part of the plan if California hopes to end the HIV epidemic in all communities. We thank Senator Wiener for his leadership and look forward to working together to further reduce barriers to PrEP and PEP in order to ensure that they are widely available to everyone.”
“PrEP and PEP are critical tools in the fight to get to zero — zero HIV transmissions, zero HIV-related deaths and zero stigma against people living with HIV,” said Equality California Executive Director Rick Zbur. “We should be doing everything we can to expand access to these medications and increase awareness of their ability to significantly reduce the risk of transmission. We’re confident this bill will do that, and we’re excited to work with Senator Wiener and Assemblymember Gloria to get it passed.”
“Community pharmacists are the face of neighborhood healthcare and provide access to important health services for millions of Californians,” said CPhA President, Veronica Bandy, PharmD, MS, BCACP. “This bill would allow pharmacists to initiate and furnish PrEP, a life-saving medication for the prevention of HIV. As the medication experts, pharmacists are uniquely qualified to partner with their patients to ensure adherence to complex medication regimens in order to receive the maximum benefit. The California Pharmacists Association (CPhA) is pleased to cosponsor this important legislation with Sen. Wiener to ensure Californians have expanded access to PrEP.”
“As California continues to grapple with a serious shortage of primary care providers, UFCW’s pharmacist members have consistently supported innovative ideas to improve access to health care for underserved Californians,” said Amber Parish Baur, Political Director for UFCW Western States Council. “In that vein, we are grateful to see thoughtful and innovative proposals like Senator Wiener’s legislation to reduce barriers to HIV prevention. As UFCW Western States Council formalizes our positions on legislation, we look forward to this year’s legislative and budget debates around these policy ideas, and we will continue to advocate for needed steps toward universal healthcare coverage and access.”
“While PrEP and PEP have now been available for many years, awareness and utilization remain low – especially among those most at risk for HIV,” said Aaron Fox, Director of Government Relations for the Los Angeles LGBT Center. “This legislation will expand knowledge of PrEP and PEP amongst health care professionals and provide an additional access point for communities.”
SB 159 is co-sponsored by the San Francisco AIDS Foundation, the Los Angeles LGBT Center, Equality California, and the California Pharmacists Association. It is also supported by the United Nurses Association of California (UNAC)/ Union of Health Care Professionals (UHCP), and United Food and Commercial Workers. SB 159 is also co-authored by Assemblymember David Chiu (D-San Francisco).
For full text of the bill, please click here.