CA lawmakers revive PrEP, STD prevention bills

  • by Matthew S. Bajko, Assistant Editor
  • Thursday January 25, 2024
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State Senator Scott Wiener, left, has seen his bill to expand PrEP access head to Governor Gavin Newsom's desk, while state Senator Caroline Menjivar has revived her bill from last year requiring public high schools to offer condoms for students. Photos: Wiener, Rick Gerharter; Menjivar, public domain<br>
State Senator Scott Wiener, left, has seen his bill to expand PrEP access head to Governor Gavin Newsom's desk, while state Senator Caroline Menjivar has revived her bill from last year requiring public high schools to offer condoms for students. Photos: Wiener, Rick Gerharter; Menjivar, public domain

A bill expanding access to the HIV prevention medication PrEP via pharmacies now awaits Governor Gavin Newsom's signature to become law. Meanwhile, legislation calling for the state's public school districts to stock condoms has been revived after Newsom vetoed it last fall.

Last September, gay state Senator Scott Wiener (D-San Francisco) pulled his Senate Bill 339 aimed at making it easier for people to receive PrEP from a pharmacist due to the Assembly Appropriations Committee inserting language into it he considered to be a "poison pill amendment." He had contended it would allow insurance companies to impose prior authorization and step-therapy for PrEP, an effective medicine for ensuring people remain HIV-negative, and PEP, which is taken immediately after someone believes they were exposed to HIV while having sex.

Because such policies are significantly limited under existing law and regulations, Wiener feared passage of the bill would reduce the patient protections already in place. He shelved the bill in order to confer with members of the Assembly committee.

Those talks in the fall and winter resulted in the amendment being removed from the legislation. It paved the way for SB 339 to be passed out of the Assembly and Senate with unanimous support from both chambers this month.

"It would have reversed the other progress we have made around PrEP access, so I am grateful Assembly leadership and the appropriations committee members really listened and allowed us to remove the amendment," said Wiener. "It would have expanded the ability of health plans to impose prior authorization on PrEP. Central to our HIV strategy is not to have prior authorizations from health insurance companies."

SB 339 should be sent to Newsom's desk by the end of the week. The governor has not said if he will sign or veto it.

"We don't typically comment on pending legislation. The governor has 12 days to act once the bill reaches his desk and will make a decision on the merits," Brandon Richards, Newsom's deputy director of communications, told the Bay Area Reporter January 24.

Last year, Newsom vetoed a number of bills with costs attached due to the state's worsening budget situation. The California Health Benefits Review Program estimates SB 339 will result in a $654,000 increase in Medi-Cal expenditures per year and cost an additional $149,000 due to beneficiaries enrolled in county organized health systems.

If enacted, the bill will increase the amount of PrEP that pharmacists are authorized to provide without a doctor's prescription and require health plans to reimburse pharmacists for PrEP services. People will still need to take a test to show they are HIV-negative and have blood work done, things pharmacists can order without the need for patients to see their primary care physician.

"I am pleased that the Legislature understands the urgency to increase access to this life-saving medication and that pharmacists are positioned to meet this need for patients," stated California Pharmacists Association President Michael Connor, PharmD.

The bill is seen as a critical piece of the state's strategy to eliminate HIV transmission. California continues to record nearly 4,000 new HIV diagnoses each year, with Black and Latino gay and bisexual men, Black cisgender women, transgender women, and youth most impacted by HIV.

"Expanding PrEP access is essential to ending the HIV epidemic in California and achieving our goals of getting to zero new HIV infections. SB 339 represents an important step forward for the state," stated San Francisco AIDS Foundation CEO Tyler TerMeer, Ph.D., a gay Black man living with HIV.

SB 339 builds on Wiener's first-in-the-nation legislation passed in 2019 that authorized people to acquire PrEP from a pharmacist without a doctor's prescription. But the bill capped the amount of PrEP pharmacists could prescribe to a 60-day supply.

Thus, it had limited impact because the amount of pills was not enough and health plans weren't covering the cost of pharmacists' labor in preparing PrEP, according to Wiener's office. With other states, such as Colorado, Nevada, and Utah, subsequently passing bills without limits on how much PrEP one can obtain via a pharmacy, Wiener authored SB 339 to change California's cap.

Under the bill, health plans would be required to cover up to a 90-day supply of PrEP prescribed by a pharmacist. They would also need to cover an ongoing supply if the patient is ensured follow-up care and testing consistent with federal PrEP usage guidelines.

"Our hope is that it will become easy for people to get PrEP from their pharmacist, the same way someone can get birth control pills from their pharmacist," said Wiener.

Speaking to the B.A.R. January 22, Wiener said he hopes Newsom will sign the bill.

"I never want to speak for the governor," he said. "But Governor Newsom has been a staunch ally on HIV issues. We are hopeful he will sign the bill."

Equality California, the statewide LGBTQ advocacy organization, co-sponsored SB 339 along with the AIDS foundation and pharmacists' professional group. The state's pharmacy board also backed the legislation, which it estimates will cost it $44,000 per year in fiscal years 2024-26, and an additional $1,000 in information technology costs from its contingency fund.

"We fully and strongly supported that bill. I am very excited it is going to the governor's desk," said Trevor Chandler, a gay San Francisco resident who sits on the oversight body. "We have been really fighting against the insurance companies opposed to PrEP expansion. We are proud to support Senator Wiener's leadership on that bill and hopeful it will be signed into law by the governor."

Newsom vetoed last year PrEP legislation authored by Assemblymember Rick Chavez Zbur (D-Santa Monica/West Hollywood). His Assembly Bill 1645 would have closed loopholes and strengthened protections in existing law to ensure that California health insurers continue to provide free and complete coverage for preventive services like PrEP and testing for STIs.

Chandler told the B.A.R. he hopes SB 339 doesn't meet a similar fate by the governor. The AIDS foundation has been asking people to contact Newsom's office to encourage him to sign the bill into law.

"Until the bill is signed, nothing is set in stone, and so we will keep up the pressure to make sure he knows the broad support this has, especially within the LGBTQ community," said Chandler, a substitute teacher who is running in November for the District 9 seat on the San Francisco Board of Supervisors.

Condoms in schools bill revived

Newsom last fall had also vetoed SB 541 authored by lesbian state Senator Caroline Menjivar (D-San Fernando Valley). In addition to requiring public high schools to offer free condoms to students, the bill would have also prohibited retailers from refusing to sell condoms to youth.

At the time Menjivar expressed frustration with Newsom's decision and indicated she wasn't giving up on the legislation. On January 22, she reintroduced it as SB 954, the Youth Health Equity + Safety (YHES) Act.

In announcing her decision to do so, Menjivar's office noted rates of sexually transmitted infections continue to rise alarmingly among youth, particularly youth of color and LGBTQ+ youth. Statewide data indicates California youth aged 15 to 24 account for more than half of all STIs. Young people in this age group make up more than five out of every 10 chlamydia cases in California, and more than 87% are youth of color, noted Menjivar's office.

"Investing in prevention is a fraction of the cost compared to the millions California spends on the treatment of STIs every year. This isn't about a catchy headline but rather the health and safety of our youth," stated Menjivar.

Some schools in the state already provide free condoms to their students — the Los Angeles and San Francisco school districts launched condom access programs in the 1990s at their high schools using federal funds. But the majority of public high schools in California do not.

Menjivar also will be requesting the state provide funding in the fiscal year 2024-2025 budget to support free condom access in public high schools statewide over a three-year period, if other funding sources are not available to schools for this purpose. An analysis of the 2023 legislation estimated it could have a price tag of as much as $4 million statewide to implement.

"We cannot continue ignoring the STI epidemic among our youth when some high schools and retailers are enacting dangerous policies that deny them the ability to protect themselves," stated Menjivar. "SB 954 aims to safeguard the health and futures of high school students statewide by increasing equitable access to condoms while also increasing fiscal responsibility."

In 2021, Vermont became the first state to require free condoms in public middle and high schools. In addition, the Chicago Public Schools Board of Education passed a new policy that requires schools that teach fifth grade and up to maintain a condom availability program.

Co-sponsoring Menjivar's bill are Generation Up, a California-based student-led social justice organization and student-activist coalition; Black Women for Wellness Action Project; the California School-Based Health Alliance; Essential Access Health, and URGE California, a youth-focused nonprofit that promotes reproductive justice.

"SB 954, the Youth Health Equity and Safety Act, is a game-changer. It's not just about condoms in schools; it's about empowering us with the knowledge and tools we need for responsible choices, fostering a safer and healthier future for all California youth," stated Martin Orea, 12th grader from Fullerton and YHES 4 Condoms youth ambassador.

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