Senator Wiener and Assemblymember Gloria’s Legislation to Increase Access to PrEP, a Once-Daily Pill to Prevent HIV, Passes Assembly Committee
Sacramento– Yesterday, 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 Assembly Committee on Health with a 13-0 vote. It now heads to the Assembly Committee on Appropriations. 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.
“We must do more to increase access to revolutionary medicines that help keep people HIV negative, and that’s exactly what SB 159 does,” said Senator Wiener. “By allowing pharmacists to furnish PrEP and PEP, we will help more people, especially low-income people and people of color, stay negative. California has some of the highest disparities between communities of color and white communities around HIV infections. SB 159 will help close that disparity by increasing access for everyone.”
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.
“With PrEP, we can end new cases of HIV in California. The challenge we face is access – more Californians need to have access to PrEP,” said Assemblymember Todd Gloria, co-author of SB 159 and vice-chair of the California Legislative LGBTQ Caucus. “SB 159 breaks down barriers so more Californians can access this life-saving medication thereby putting us closer to eradicating HIV/AIDS.”
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.
"PrEP and PEP are critical tools in the fight to get to zero — zero new HIV transmissions, zero HIV-related deaths and zero stigma against people living with HIV - and expanding access to these drugs is particularly important for communities of color and rural communities, where barriers to care are higher,” said Rick Zbur, Equality California Executive Director. “We can't thank Senator Wiener and Assemblymember Gloria enough for their leadership in this fight. And we are grateful to the members of the Assembly Health Committee who voted to expand access to these life-saving HIV prevention medications.”
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.