Pharmacist Prescribing Helps Pave the Way to PrEP Access in Several States

Commentary
Article

Variations and conditions included in existing state bills, however, limit the effectiveness of this approach.

The CDC identifies pre-exposure prophylaxis (PrEP) therapy as highly effective in preventing HIV, but estimates that only 25% of the 1.2 million people who could benefit are receiving prescriptions for PrEP therapy. Increasing the availability and number of clinicians offering PrEP are among the strategies that the CDC recommends for improving access to and acceptance of PrEP.1

A team of pharmacists from the University of California searched for state legislative bills using pharmacist prescribing to expand patient access to PrEP.2 The exercise identified 12 states (Arkansas, California, Colorado, Connecticut, Illinois, Maine, Nevada, New Mexico, Oregon, Rhode Island, Utah, and Virginia) with legislative bills supporting independent provision of PrEP by pharmacists and analyzed the content of each bill.2

young man with a PrEP pill

Image credit: nito | stock.adobe.com

Most bills require additional training before the state permits pharmacists to prescribe PrEP. Training requirements differ between states, with variations in content and oversight. Statewide protocols and/or standing order requirements for PrEP are also common among the existing bills.2

The majority of bills outline administrative and clinical conditions for pharmacist prescribing of PrEP. Administrative conditions include documentation, physician notification, dispensing quantities, and patient referrals. Clinical conditions include prescribing information included in the medication package insert, patient symptoms, other medications, and laboratory test results.2

Laboratory tests for appropriate prescribing of PrEP add complexity to pharmacist prescribing. Several of the bills attempt to advance pharmacist practice through lab testing, although others do not address or contain only vague language about a pharmacist’s ability to order laboratory tests.2

Only half of the bills contain language about pharmacist reimbursement for PrEP services, with recommendations ranging from “reasonable fees” to reimbursement rates of 85% to 100% of nurse practitioner or physician rates.2

The researchers concluded that pharmacist prescribing is a promising approach to expanding access to PrEP therapy among qualifying individuals. Variations and conditions included in existing state bills, however, limit the effectiveness of this approach. For future success, the authors suggest that new bills support pharmacist-led PrEP interventions holistically and address barriers such as laboratory tests and reimbursement.2

About the Author

Lori R. Donnelly, PharmD, is a consultant at BluePeak Advisors in Rolling Meadows, Illinois.

References

1. Centers for Disease Control and Prevention. Ending the HIV Epidemic in the U.S. Updated June 15, 2022. Accessed January 7, 2024. https://www.cdc.gov/endhiv/indicators/prevent.html 

2. Cocohoba J, Tweedie L, Frank M, et al. Legislation expanding pharmacist scope of practice to furnish Human Immunodeficiency Virus pre-exposure prophylaxis: A content analysis. J Am Coll Clin Pharm. 2023; 1-6. doi:10.1002/jac5.1906

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