Senator Wiener and Assemblymember Gloria’s Legislation to Increase Access to PrEP, a Once-Daily Pill to Prevent HIV, Passes Assembly

Sacramento–  Today, 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 with a 65-0 vote. It now heads back to the Senate floor for final sign-off. 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.) Regarding PrEP, pharmacists will be able to provide a 60-day supply, after which the patient will need to see a physician to continue. 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.

“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.” 

“With PrEP, we can end new cases of HIV in California. The challenge we face is access – more Californians should have easy and equitable access to this life-saving medication,” said Assemblymember Todd Gloria. “SB 159 breaks down barriers so more Californians can access PrEP which puts us closer to eradicating HIV/AIDS. I’m proud to be a co-author of this bill, and I hope Governor Newsom will sign it into law.”

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 can — and will — eliminate HIV transmissions, HIV-related deaths and stigma against people living with HIV," said Equality California Executive Director Rick Zbur. "PrEP and PEP are critical tools in that effort, and the Assembly's bipartisan vote to expand access to these lifesaving drugs is another giant leap forward."

“Californians have not had equitable access to PrEP and PEP and, as a result, we have seen disparities in HIV transmission rates in communities throughout the state,” said San Francisco AIDS Foundation CEO Joe Hollendoner. “SB 159 will make it easier for all Californians to gain access to these effective HIV prevention tools and, ultimately, will bring our state closer to ending HIV transmission.  San Francisco AIDS Foundation is thankful to the California Assembly for their support of this life-saving legislation and Senator Wiener for his steadfast commitment to ending 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.

“The California Pharmacists Association is honored to have worked on this important public health bill,” said California Pharmacist Association President Dr. Veronica Bandy.  “We understand that pharmacists have a role in doing everything we can to help people protect themselves from contracting HIV. By working together with patient advocates, community resources and the medical community, we can help eliminate the spread of this disease.”

“Insurance prior authorization requirements have long been a significant barrier to PrEP uptake,” said APLA Health CEO Craig E. Thompson. “These policies delay access to life-saving medication, make it more difficult to remain adherent, and increase the likelihood that vulnerable individuals will acquire HIV. We applaud the Assembly for taking this critical step toward increasing PrEP use and reducing new HIV transmissions in California.”

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.