California became the first state to allow pharmacists to dispense HIV prevention pills to patients without a doctor’s prescription, with the passage of SB 159. Supporters say the legislation will greatly reduce the spread of infection.1

According to the CDC, pre-exposure prophylaxis (PrEP) can reduce the risk of contracting HIV by about 99% when taken daily. In patients who inject drugs, PrEP reduces the risk of HIV by at least 74% when taken daily.1 Post-exposure prophylaxis (PEP) is a 28-day preventative course for those who may have been exposed to HIV. PEP is also effective, but alternative safety measures, such as condoms, should also be implemented.2

Advocates of California’s law say it will improve access and reduce stigma, especially for minority patients and those in rural areas.

The law not only allows pharmacists to dispense PrEP medications without a prescription, but also prohibits insurance companies from requiring patients to get prior authorization before using insurance to get the drugs.1 That can be a significant barrier to accessing medications, due to stigma and time constraints. For example, PEP is only effective if started within 72 hours of exposure to the virus, but not everyone can get to a physician in that time frame.2

Many patients also face stigma from physicians and other health care providers when they seek PrEP and PEP drugs. Some pharmacists, such as Christina Garcia, PharmD, are combating this stigma with pharmacies, such as TIN Rx in San Francisco, which is a “stigma-free” pharmacy serving the LGBTQ populations and others who may face stigma.

“I’m very thrilled to have our governor sign SB 159,” Garcia said. “This will change our practice for the better.”

The bill was co-authored by Sen. Scott Wiener, D-San Francisco, who has publicly said he takes PrEP as an HIV prevention method.1

“SB 159 will keep more Californians HIV-negative and help us end this epidemic,” Wiener said in a statement. “I applaud Governor Newsom for signing this first-in-the-nation legislation to remove barriers to these critical HIV-preventatives.”3

The bill was also sponsored by Equality California, the San Francisco AIDS Foundation, APLA Health, the Los Angeles LGBT Center, the California Pharmacists Association, and the California Society of Health-System Pharmacists.

According to the Associated Press, the California Medical Association initially opposed the legislation but became neutral after it was amended to limit the number of PrEP pills patients can get without a physician’s note. That number is limited to 60 days, because the association was concerned about long-term use without physician oversight.

There is still more work to do, however, to ensure the bill is implemented, according to advocates.

“Our work doesn’t stop here,” Garcia said. “We are going to work with the Board of Pharmacy to have this adopted and implemented in the state.”


REFERENCES
  1. Associated Press. California Oks pharmacists to dispense HIV prevention meds. AP website. https://www.apnews.com/a1491134e0c242bc95ef36ed0a9fa95e. Published October 7, 2019. Accessed October 9, 2019.
  2. Centers for Disease Control and Prevention. HIV: Basics: PrEP CDC website. https://www.cdc.gov/hiv/basics/prep.html. Reviewed September 25, 2019. Accessed October 9, 2019.
  3. Governor Signs Senator Wiener and Assemblymember Gloria’s Groundbreaking Legislation to Expand Access to PrEP, a Once-Daily Pill to Prevent HIV. [email] Created October 8, 2019. Accesed October 8, 2019.