Gov. Gavin Newsom signed groundbreaking legislation Monday that will make California the first state in the nation to allow patients to buy HIV prevention pills from pharmacists without a prescription.
Senate Bill 159
The legislation also prohibits insurance companies from requiring patients to obtain prior authorization before using their insurance benefits to obtain these critical HIV prevention medications. Pharmacists already are authorized to furnish emergency contraceptives and the birth control pill without a prescription.
When Senate Bill 159 goes into effect on January 1, 2020, California will authorize pharmacists to furnish at least a 30-day supply — and up to a 60-day supply — of pre-exposure prophylaxis (PrEP) and a complete 28-day course of post-exposure prophylaxis (PEP) without a physician’s prescription. After two months on PrEP, a patient will need to see a physician for ongoing PrEP prescriptions.
PrEP and PEP are covered by most private insurance plans, as well as Medicare and Medi-Cal. For individuals who need financial assistance to help pay for the medications, California has launched a statewide PrEP Assistance Program. The program is run by the California Office of AIDS.
HIV prevention pills
Supporters of the legislation say the action will greatly reduce barriers to PrEP and PEP. For example, PEP significantly reduces the risk of HIV infection if taken within 72 hours of exposure, but patients may not always be able to see a doctor in that time frame.
The law was co-authored by state Sen. Scott Wiener, (D-San Francisco), who has publicly said that he takes PrEP as an HIV prevention strategy. Assemblyman Todd Gloria (D-San Diego) is the other co-author.
PrEP and PEP are critical tools to ending the HIV epidemic in California and across the country. PrEP is a once-daily pill for HIV-negative people that almost entirely eliminates the risk of acquiring HIV.
Communities at risk
Despite the importance of these HIV prevention interventions, recent data from the Centers for Disease Control and Prevention suggest that less than 25 percent of people who could benefit from PrEP take it.
PrEP usage has been lowest among populations most affected by HIV, including black and Latinx gay and bisexual men, transgender people, women, and youth. Health advocates hope expanding access to PrEP will lower the number of new diagnoses in communities with a high incidence of HIV.
For example, in 2016, the Center for Disease Control found that men who have sex with men accounted for two-thirds of new HIV diagnoses. Of that figure, Latino men were almost twice as likely and black men were more than three times as likely to contract HIV as white men.
Also in 2016, the California Department of Public Health estimated from 220,000 to 240,000 Californians could benefit from PrEP, but only 9,000 people, or less than 4 percent, take the drug.
Doctors recommend that people who take PrEP daily test their kidney function every three months and undergo routine testing for HIV and other sexually transmitted infections.
Senate Bill 159 is supported by a broad coalition and sponsored by Equality California, San Francisco AIDS Foundation, APLA Health, Los Angeles LGBT Center, California Pharmacists Association, and California Society of Health-System Pharmacists.