US State Prescribing Laws May Limit Access to HIV Pre-Exposure Prophylaxis


These findings suggest people with indications for PrEP may confront an access barrier if they live in a state that restricts scope of practice, according to the study.

State laws in the United States that require physicians to determine which medications a nurse practitioner (NP) or physician assistant (PA) can prescribe and under what conditions may limit the number of patients with HIV who use pre-exposure prophylaxis (PrEP), according to a study in The Journal of the Association of Nurses in AIDS Care.

Previous research established that some physicians were not willing to prescribe PrEP or had reservations about prescribing PrEP to certain or all indicated populations. These findings suggest people with indications for PrEP may confront an access barrier if they live in a state that restricts scope of practice, according to the study. Further, patients who are in the care of NPs and PAs being supervised by physicians who are not knowledgeable about, who hold a certain attitude toward, or are unwilling to prescribe PrEP may also face access challenges. A critical step to reach these necessary saturation levels is to address legal and policy barriers to PrEP access, according to the study.

Each state has scope of practice laws that specify the degree of autonomy NPs and PAs have when diagnosing conditions and prescribing controlled medications. To further examine whether there is a correlation between those laws and prescriptions for PrEP, Neal A. Carnes, PhD, and colleagues analyzed nationwide data on more than 79,000 people who received a PrEP prescription in 2017.

The team identified statistically significant differences in the number of PrEP prescriptions written by NPs or PAs according to the state scope of practice laws:

  • NPs in states that allowed independent practice, which means they can prescribe PrEP without oversight, or transition to independent practice after a period of supervision, were 40% more likely to prescribe PrEP than NPs in states that required oversight by a physician.
  • PAs in states where the law or a state board gives them the ability to prescribe PrEP were 2.6 times more likely to prescribe PrEP than PAs that required oversight by a physician.

The research team noted that the federal “Ending the HIV Epidemic in the United States” initiative aims to reduce new HIV infections in the United States by 90% by 2030 by scaling up key HIV prevention and treatment strategies. Because the increased use of PrEP is vital to that effort, the researchers suggest that other states consider expanding PrEP detailing and education efforts that focus on physicians, as well as the NPs and PAs they supervise. Expanding OTC PrEP would also help to alleviate the scope of practice oversight as an access barrier, according to the study.


State laws about prescribing may limit access to HIV pre-exposure prophylaxis. EurekAlert! January 21, 2022. Accessed January 24, 2022.

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