Senator Wiener’s Bill to Expand Access to PrEP Stalls Due to Poison Pill Amendment
SACRAMENTO – Senator Scott Wiener (D-San Francisco) announced today that he is pausing Senate Bill 339 in the Assembly after the Assembly Appropriations Committee inserted a harmful amendment to the bill. SB 339 improves access to PrEP and PEP, a powerful preventative HIV medication, by ensuring pharmacists can furnish PrEP without a prescription. The bill deals exclusively with ensuring pharmacists are able to provide PrEP.
Last week, the Assembly Appropriations Committee inserted an extraneous amendment into SB 339 having nothing to do with the bill — essentially inserting an unrelated bill into this bill — and which *undermines* access to PrEP. The amendment would allow insurance companies to impose prior authorization and step-therapy for PrEP and PEP, which are significantly limited under existing law and regulations. In other words, the amendment reduces patient protections.
This harmful amendment is not only completely unrelated to the purpose of the bill – i.e., improving pharmacists’ ability to furnish PrEP and PEP – but it also upends longstanding guidance from state regulators and runs counter to California’s ongoing efforts to improve access to PrEP and PEP for Californians most at risk for contracting HIV.
Because these amendments undermine PrEP access, they’re effectively a poison pill and therefore untenable. The amendments were never analyzed or voted on by a health policy committee, and Senator Wiener opposes them. As a result, Senator Wiener has chosen not to move SB 339 forward at this time. Over the recess, Senator Wiener will determine if there is a path to deleting these harmful amendments. If not, he likely will abandon the bill.
“It’s heartbreaking to see a straightforward, critically important HIV prevention bill stall this way,” said Senator Wiener. “Thousands of Californians contract HIV each year, and we need common sense measures like SB 339 to improve access to PrEP.”
Despite significant public health advancements, HIV remains a major public health challenge in California, with nearly 4,000 new HIV diagnoses each year. Black and Latino gay and bisexual men, Black cisgender women, transgender women, and youth continue to be the populations most impacted by HIV.
PrEP is a preventative drug taken orally or intravenously that reduces the risk of contracting HIV through sexual contact by more than 99%, making it more effective than any other measure to prevent HIV, including condoms. Despite its incredible efficacy, fewer than 25 percent of those who would benefit from PrEP are using these medications.
“We are shocked at the recent actions of the Assembly Appropriations Committee to reverse years of advocacy for HIV prevention in California and roll back essential protections for people at risk of acquiring HIV,” says Dr. Tyler TerMeer, CEO of the San Francisco AIDS Foundation, “For decades California has been at the forefront of HIV prevention, ensuring that people had access to PrEP, our most effective form of HIV prevention, without delays caused by insurance red tape and greed. The language changes added by the Appropriations Committee would undo that work and leave people at the highest risk of HIV vulnerable to pointless bureaucratic delays and denials, increasing HIV transmission and undoing our work to get to zero new HIV infections in California.”
Michael Conner, PharmD, President of the California Pharmacists Association states, “While the current version of the bill meets the goal of CPhA to allow pharmacists to independently initiate and provide PrEP/PEP, it removes protections for patients. Our commitment is to do what is in the best interest of patients, it is at the heart of what we do. Therefore, we cannot support moving the bill forward at this time. We look forward to working together to move a bill that meets the intention of improving access to these life-saving medications.”
“We are disappointed that SB 339 will not be advancing this year because of the Assembly Appropriations Committee’s amendments — we could not in good conscience move forward with the amended bill and roll back years of progress in the fight against HIV,” said Equality California Executive Director Tony Hoang. “The amendments would take California back to a time when health plans could impose onerous delays to accessing critical HIV prevention medications and they demonstrate a disregard for the HIV providers and advocates who have been fighting for years to improve PrEP access in California. We remain fully committed to expanding PrEP access for all Californians and look forward to continuing our work with Senator Wiener on this important issue.”
Background on SB 339
In 2019, Governor Newsom signed the first-in-the-nation Senate Bill 159 (Wiener, Chapter 532, Statutes of 2019) into law. The legislation authorized pharmacies to furnish up to a 60-day supply of PrEP without a prescription. It also banned health plans from imposing step therapy and prior authorization on PrEP.
However, few pharmacies have successfully used the law to furnish PrEP. In surveys, providers cited the fact that health plans do not cover the cost of pharmacists’ labor in preparing PrEP as a major obstacle, and that the 60-day window is too short to ensure referral to a primary-care physician.
Other states have successfully implemented pharmacy-provided PrEP programs. Colorado, Nevada, and Utah opted not to limit the amount of HIV-preventative medication a pharmacist can provide. In Colorado, plans must reimburse a pharmacist employed by an in-network pharmacy for prescribing and dispensing PrEP and PEP to a covered person, and to provide an adequate consultative fee to those pharmacists. In Nevada, both public and private plans must include coverage for PrEP and PEP and reimburse for laboratory testing, prescribing, dispensing, and administering these medications by a pharmacist at a rate equal to that of a physician.
SB 339 takes lessons from other states to address the unforeseen obstacles of California’s first-in-the-nation effort of SB 159, opening pathways to the increased uptake envisioned when the bill was originally passed. SB 339 requires health plans to cover up to a 90-day supply of PrEP prescribed by a pharmacist, and an ongoing supply if the patient is ensured follow-up care and testing consistent with CDC guidelines. It also requires health plans to cover costs associated with pharmacist services when furnishing PrEP including but not limited to testing. These measures will remove the most significant reported barriers to making PrEP available without a prescription.