State closes loophole to make HIV pills more available
Gov. Gavin Newsom signed into law on Tuesday a bill that makes PrEP — a daily pill that prevents HIV infection — easier to access at pharmacies, potentially improving use statewide and especially in communities where rates of disease have remained stubbornly high.
The bill corrects earlier legislation, signed in 2019, that made California the first state in the nation to allow pharmacists to provide PrEP without a doctor’s prescription. But that legislation included critical limitations that prevented wide implementation among pharmacists.
The new law, passed by the Legislature last month, closes those loopholes and, public health experts hope, will make a significant dent in the state’s HIV infection rates.
“We know that PrEP is a critical part of any strategy to end HIV infection,” said Sen. Scott Wiener, D-San Francisco, who introduced the 2019 legislation as well as the updated bill. “But so many people who should be on PrEP are not on PrEP. There is a significant lack of access and way too many barriers.”
PrEP, which stands for pre-exposure prophylaxis, is more than 99% effective at preventing HIV infection when taken as prescribed. It can be taken by pill or given by injection; the new legislation applies only to the pills.
The preventive medication has been a cornerstone of efforts to end the AIDS epidemic altogether someday, and already is responsible for dramatically lowering rates of infection in much of the world.
But most people who would benefit from taking PrEP are not on the drug, public health experts say, and that’s particularly true in vulnerable communities that have been especially hard hit by AIDS. For example, nationally, Black people accounted for 42% of new HIV infections in 2021, but only 14% of PrEP users, according to Emory University’s AIDSVu, which tracks HIV demographic data.
California reports roughly 4,000 new HIV infections each year, about a 30% drop over the past 15 years attributed in part to PrEP. Statewide, about 30% of people who should be on PrEP are taking it, according to the U.S. Centers for Disease Control and Prevention. In San Francisco, which has among the highest PrEP rates in the country, more than three-quarters of people who are recommended for PrEP are taking it, according to the San Francisco Department of Public Health.
“When someone has PrEP, they’re reducing their chances of HIV tremendously,” said Jorge Reyes Salinas, spokesperson for Equality California, which sponsored the new legislation. “We’ve seen that the numbers can be reduced in communities of color and immigrant communities that are more aware of the medications they can take.”
Being able to access PrEP from a pharmacy could make a big difference for people who don’t have a primary care provider or live in a part of the state where the closest doctor is a long drive away, Salinas said.
“Allowing someone to go to their neighborhood pharmacy, where they’re probably going multiple times a week anyway, is a really effective way of increasing access and just making it easier for people to start and keep using PrEP,” Wiener said.
Under the new legislation, pharmacists can provide PrEP for up to 90 days, and beyond that on an ongoing basis as long as certain tests and follow-up care are provided. The previous law had allowed for only a 30-day supply from pharmacists before forcing patients to a physician for longer-term care.
The new law also requires health insurance plans to cover not only the pills but testing and other services provided by pharmacists when offering
PrEP. Previously, pharmacists were not reimbursed for consultations, which could take 15 to 30 minutes, or lab tests, including HIV tests to confirm people on PrEP are uninfected.
“There’s been very low uptake of this service” since the first law was signed in 2019, said Richard Dang, former president of the California Pharmacists Association, which sponsored both bills.
Dang, who runs an outpatient pharmacy associated with the University of Southern California, said he had wanted to start offering PrEP when the first legislation was passed, but his team realized it would be inefficient and even irresponsible to send patients away with only one month of pills.
“Pre-exposure prophylaxis is something you should be taking every day, with no gaps,” Dang said. “Many pharmacists said it felt like doing a disservice to start them for 30 days and then drop them.”
Dang said he was optimistic that would change now.
“A few colleagues who own their own pharmacies say they have plans to get services up and running,” he said. “It’s all about giving patients options and choices.”