Andy Fyne, Testing & Prevention Manager
PrEP and PEP are exciting and important strategies for helping us to prevent new HIV infections. But both medically-based prevention strategies are suffering from alarmingly low levels of use. The Spahr Center is engaging in advocacy of state legislation to address this problem by allowing pharmacists to provide both PrEP and PEP to people who request it. You can help secure passage of this important legislation, and help make sure people you care about know of these prevention strategies.
PrEP (PRE-exposure prophylaxis) is a once-daily pill for HIV-negative people that almost entirely eliminates the risk of contracting HIV. PEP (POST-exposure prophylaxis), on the other hand, is medication that a person takes after potential exposure to HIV, in order to prevent the virus from taking hold. PEP is a 28-day course of drugs that, if started within 72 hours after exposure to HIV, significantly reduces risk of infection. Both PrEP and PEP are exciting and valuable strategies to prevent new HIV infections and to ultimately end the epidemic. Yet, PrEP uptake, in particular, has been frustratingly slow. The CDC estimates that only 10-15% of people in California who could benefit from PrEP are currently taking it, and use is low in communities most affected by HIV such as communities of color, women and youth. PEP uptake is also low, and it can be difficult for people to access PEP within the critical first 72 hours of potential exposure. This can be due to complications when seeking a prescription in an emergency room setting, problems getting a doctor’s appointment, insurance complications or other barriers.
A bill to lessen some of these barriers is making its way through our State Legislature. SB 159 would authorize pharmacists to provide pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to patients without a physician’s prescription. (Pharmacists are already authorized to furnish emergency contraceptives and the birth control pill without a prescription.) The legislation would also prohibit insurance companies from requiring patients to obtain authorization before using their insurance benefits to obtain PrEP or PEP. Both provisions would expand access to PrEP and PEP by increasing the places where people can access these medications, increasing the number of healthcare professionals who can provide it, and removing onerous and unnecessary insurance barriers.
Lobbying for SB159 was our focus when a group of activists from the Spahr Center traveled to Sacramento on May 14th as part of LGBTQ Advocacy Day 2019. Spahr Center board member, Wade Flores, HIV Care Council member, Elaine Flores and I joined other PrEP/PEP advocates from across the State to share our experiences helping others get these prevention medications. We had the opportunity to visit the offices of two assembly members and two Senators, including our own Senator Mike McGuire. It was empowering to educate them about the needs that still exist in our efforts to prevent new HIV infections, and to learn of their support on this issue.
The Spahr Center delegation spoke for people without adequate access to health care and for the people unable to access clinics easily. We let it be known that the ability to get PrEP and PEP from a local pharmacy was a common sense and safe way to make PrEP/PEP much more available. Allowing pharmacists to furnish these medications will increase the number of individuals who choose to take PrEP or PEP. Pharmacists are well-qualified to discuss the importance of this medication with their patients. Because PrEP and PEP both require strict adherence to a regimen, pharmacists are also able to support patients to adhere to the medical requirements. Due to PEP’s time sensitivity, removing the pre-authorization requirement is especially important to guarantee that people can get the medicine within the first 72 hours post exposure.
PrEP and PEP are covered by most private insurance programs, as well as by Medicare, Medi-Cal, and Covered California health plans.
On May 21, 2019, SB159 passed the Senate on a vote of 34-1. It now heads to the Assembly for committee hearings in the coming weeks. Keep your eyes on Sparkle for updates and consider writing your Assembly Member to do some advocacy work yourselves. findyourrep.legislature.ca.gov In the meanwhile, if you know anyone who might benefit from PrEP and could use some coaching about how to get it, please tell them I am happy to assist. Call Andy at 415-886-8556.