Bill to improve access to PrEP through pharmacies introduced

State Senator Scott Wiener (D-San Francisco) introduced Senate Bill 339, legislation to improve access to PrEP, the preventative HIV medication. SB 339 will rectify issues with previous legislation to allow pharmacies to furnish PrEP without a prescription.

The new legislation will extend the length of time for which pharmacies may furnish PrEP without a prescription and require health plans to cover the costs of pharmacists’ time in preparing PrEP.

“PrEP freed millions of people from the fear of contracting HIV, a miracle of science that once seemed impossible,” said Wiener. “However, each year around 4,000 Californians – disproportionately LGBTQ people and people of color – contract HIV because of barriers to access. SB 339 will address the issues with implementing our groundbreaking legislation SB 159, allowing people to access PrEP without seeing a doctor.”

Despite significant progress, HIV remains a major public health challenge in California, with nearly 4,000 new HIV diagnoses each year. Black and Latino gay and bisexual men, Black cisgender women, transgender women, and youth continue to be the populations most impacted by HIV.

PrEP reduces the risk of contracting HIV through sexual contact by more than 99%, making it more effective than any other measure to prevent HIV, including condoms. PrEP reduces the risk of contracting HIV via drug use by 74%.

In 2019, Governor Newsom signed the first-in-the-nation Senate Bill 159 (Wiener, Chapter 532, Statutes of 2019) into law. The legislation authorized pharmacies to furnish up to a 60-day supply of PrEP without a prescription. It also banned health plans from imposing step therapy and prior authorization on PrEP.

However, few pharmacies have successfully used the law to furnish PrEP. In surveys, because health plans do not cover the cost of pharmacists’ labor in preparing PrEP as a major obstacle and because the 60-day window is too short to ensure referral to a primary-care physician.

Other states have successfully implemented pharmacy-provided PrEP programs. Colorado, Nevada, and Utah opted not to limit the amount of HIV-preventative medication a pharmacist can provide.

In Colorado, plans must reimburse a pharmacist employed by an in-network pharmacy for prescribing and dispensing PrEP and PEP to a covered person, and to provide an adequate consultative fee to those pharmacists.

In Nevada, both public and private plans must include coverage for PrEP and PEP and reimburse for laboratory testing, prescribing, dispensing, and administering these medications by a pharmacist at a rate equal to that of a physician.

SB 339 addresses the unforeseen obstacles of California’s first-in-the-nation effort of SB 159, opening pathways to the increased uptake envisioned when the bill was originally passed. SB 339 requires health plans to cover up to a 90-day supply of PrEP prescribed by a pharmacist, and an ongoing supply if the patient is ensured follow-up care and testing consistent with CDC guidelines.

It also requires health plans to cover costs associated with pharmacist services when furnishing PrEP including but not limited to testing. These measures will remove the most significant reported barriers to making PrEP available without a prescription.

SB 339 is sponsored by the California Pharmacists Association, Equality California, and the SF AIDS Foundation.

“When we passed the legislation granting pharmacists the authority to initiate and provide life-saving medication to prevent HIV, our shared goal is to get to zero transmissions,” said Richard Dang, PharmD, President, California Pharmacists Association. “However, until health plans treat pharmacists as other healthcare providers and reimburse us for care and remove unnecessary barriers, we will not meet that goal. Pharmacists and physicians work together to ensure our patients maintain their health, we must require health plans to recognize pharmacists as key members of the healthcare team.”

“Equality California was proud to co-sponsor SB 159 in 2019, which made California the first state in the nation to allow pharmacists to provide PrEP and PEP without a physician’s prescription,” said Equality California Executive

Director Tony Hoang. “Unfortunately, few pharmacists currently provide these medications and LGBTQ+ Californians continue to experience numerous barriers to accessing them. By co-sponsoring SB 339, we remain committed to eliminating these barriers, which will help reduce HIV transmission rates and create a stronger path toward ending the HIV epidemic entirely.”

“San Francisco AIDS Foundation is proud to co-sponsor SB 339 which builds on the groundbreaking provisions of SB159 by allowing pharmacists to provide ongoing PrEP and associated testing and follow-up care,” said Tyler TerMeer, PhD, CEO of SF AIDS Foundation. “It is critical that we increase access to this effective HIV prevention tool, in order to reduce disparities in new infections. Currently, less than 25% of those who could benefit from PrEP are receiving it, and uptake is particularly low among Black and Latinx-identified men who have sex with men, transgender individuals, and people living in rural areas with limited access to culturally competent healthcare providers. Diversifying the providers and places where people can access ongoing PrEP would be a step toward more equitable access for all Californians.”

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