Newsom Signs Historic Bill Expanding Access to HIV Prevention Medication

California Will Be First State to Allow Pharmacists to Furnish PrEP and PEP Without a Physician's Prescription

SACRAMENTO, Calif. - October 7, 2019 - California Governor Gavin Newsom signed Sen. Scott Wiener (D-San Francisco) and Asm. Todd Gloria's (D-San Diego) SB 159 - co-sponsored by Equality California - on Monday, expanding access to life-saving HIV prevention medication. When SB 159 goes into effect on January 1, 2020, California will become the first state in the nation to 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 course of post-exposure prophylaxis (PEP) without a physician's prescription. The legislation also prohibits insurance companies from requiring "step therapy" or prior authorization for anti-retroviral drugs, including PrEP and PEP. The bill is a key step in California's work to eliminate HIV and delivers on Newsom's campaign pledge to take aggressive action to end the HIV epidemic.

Equality California, the nation's largest statewide LGBTQ civil rights organization and a co-sponsor of SB 159, released the following statement from Executive Director Rick Zbur:

"The HIV epidemic is still a pressing issue today - especially for LGBTQ people of color and folks in rural communities. But with Governor Newsom's signature, SB 159 is a giant step forward in getting to zero transmissions, zero deaths and zero stigma. By increasing access to life-saving HIV prevention medication, California - unlike the White House - is leading the country in the race to eliminate HIV. We owe a debt of gratitude to Senator Wiener and Assemblymember Gloria for their leadership and tireless advocacy."

SB 159 enjoyed overwhelming bipartisan support in both the Senate and the Assembly, passing both chambers with nearly unanimous support. In addition to Equality California, SB 159 was co-sponsored by the San Francisco AIDS Foundation, APLA Health, the Los Angeles LGBT Center and the California Pharmacists Association. In addition to Assemblymember Gloria, 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.

Background:

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.

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 White gay men. 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.

Despite their effectiveness, several barriers limit access to PrEP and PEP. These barriers include against LGBTQ people, patient distrust of healthcare professionals or an expectation that providers will judge patients seeking antiretroviral medication, high costs for patients, scarcity of healthcare facilities, challenges getting appointments with physicians, burdensome prior authorization requirements, and an insufficient number of providers who are knowledgeable about 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.

About Equality California:

Equality California is the nation's largest statewide LGBTQ civil rights organization. We bring the voices of LGBTQ people and allies to institutions of power in California and across the United States, striving to create a world that is healthy, just, and fully equal for all LGBTQ people. We advance civil rights and social justice by inspiring, advocating and mobilizing through an inclusive movement that works tirelessly on behalf of those we serve. www.eqca.org