In recent months, legislation to increase access to pre- and post-exposure prophylaxis (PrEP and PEP) passed in California with a vote of 34-1 in the Senate and a unanimous vote in the Assembly. The appropriations committee will continue discussing the bill in a hearing on Wednesday.1

SB 159 authorizes pharmacists to provide PrEP and PEP without a physician prescription, prohibits insurance companies from requiring patients to obtain prior authorization before using their insurance benefits to obtain the drugs, and requires insurance coverage of pharmacist-prescribed PrEP and PEP.2 Both provisions would increase places where people can access the medications, increase the number of health care professionals who can provide it, and remove insurance barriers.

PrEP is a once-daily pill for HIV-negative people that almost entirely eliminates the risk of contracting HIV. PEP is a 28-day course of drugs to be taken after exposure to HIV, which significantly reduces risk of infection if taken within 72 hours.2

Increasing access to PrEP and PEP can drastically reduce the occurrence of HIV among those at risk of contracting the disease. According to the CDC, studies have demonstrated that PrEP reduces the risk of contracting HIV via sex by 99% when taken daily. Among those who inject drugs, PrEP reduces the risk of contraction by at least 74% when taken daily.3

Accessing PrEP and PEP can be difficult, however, with barriers including stigma, high costs for patients, scarcity of facilities, and prior authorization requirements. Several California health plans currently require documentation to request prior authorization every three months for PrEP, which can put patients at risk for delays and medication interruptions according to Equality California.

Fiscal effects of the bill for the Board of Pharmacy would include $65,000 in the fiscal year 2020-2021, $60,000 in 2021-2022, and ongoing staffing and information technology costs. The California Health Benefit Review Program (CHBRP) estimates a $7.6 million increase in employer-funded premium costs in the private insurance market.1

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References
  1. California SB159. TrackBill. https://trackbill.com/bill/california-senate-bill-159-hiv-preexposure-and-postexposure-prophylaxis/1650156/. Accessed August 20, 2019.
  2. Legislation to Increase Access to PrEP Unanimously Passes Assembly Committee. Equality California. https://www.eqca.org/release-sb159-assembly-committee-health/. Published July 10, 2019. Accessed August 20, 2019.
  3. PrEP | HIV Basics | HIV/AIDS | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/prep.html. Accessed August 20, 2019.