Newsom signs PrEP expansion bill into law

  • by Matthew S. Bajko, Assistant Editor
  • Tuesday February 6, 2024
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Governor Gavin Newsom. Photo: From X
Governor Gavin Newsom. Photo: From X

Governor Gavin Newsom has signed into law a bill expanding access to the HIV prevention medication PrEP via pharmacies. He did so Tuesday without comment.

Senate Bill 339 makes it easier for people to receive PrEP from a pharmacy without having to first talk to their primary care physician. It requires health plans to cover up to a 90-day supply of PrEP prescribed by a pharmacist.

It also requires them to cover an ongoing supply if the patient is ensured follow-up care and testing consistent with federal guidelines for the usage of PrEP. The medicine is an effective intervention for keeping people HIV-negative and a key part of health officials' efforts to eliminate the nearly 4,000 new HIV diagnoses annually reported in California.

"PrEP is a daily pill that almost entirely eliminates HIV risk. SB 339 will help California achieve our goal of eliminating new HIV infections," wrote gay state Senator Scott Wiener (D-San Francisco) in a February 6 post on social media site X.

Wiener, who is on PrEP, had authored SB 339 as a follow up to his first-in-the-nation legislation passed in 2019 that authorized people to acquire a 60-day supply of PrEP from a pharmacist without a doctor's prescription. Yet 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 had introduced SB 339 last year to change California's cap. But he ended up pulling the legislation last summer after the Assembly Appropriations Committee inserted language into it Wiener considered to be a "poison pill amendment," as the Bay Area Reporter previously reported.

He had contended it would allow insurance companies to impose prior authorization and step-therapy for PrEP and PEP, which is taken immediately after someone believes they were exposed to HIV while having sex. Such policies are significantly limited in California under existing state law and regulations.

After Wiener engaged with his Assembly counterparts last fall and winter, they reached an agreement to remove the amendment language from the bill. It paved the way for SB 339 to be passed out of the Assembly and Senate with unanimous support from both chambers last month.

"Central to our HIV strategy is not to have prior authorizations from health insurance companies," Wiener noted.

With SB 339 becoming law, health plans will now also have to reimburse pharmacists for their 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.

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.

"HIV continues to take a huge toll on public health in California, and SB 339 unlocks a powerful tool to prevent new infections," stated Wiener. "PrEP is nearly 100% effective at preventing HIV transmission, but far too many Californians lack access to it. Allowing people to obtain this powerful anti-HIV tool at their neighborhood pharmacy will greatly expand access and is a big step toward a future free from new HIV cases."

Equality California, the statewide LGBTQ advocacy organization, co-sponsored SB 339 along with the San Francisco 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.

"On behalf of the members of the California Pharmacists Association, I want to thank Senator Wiener and our co-sponsors for their tireless efforts to remove barriers to pharmacists' ability to independently initiate and provide PEP/PrEP," stated California Pharmacists Association President Michael Connor, PharmD. "Every individual who chooses to receive this life-saving medication from their community pharmacy should be able to do so. I would also like to extend our gratitude to the Governor for signing this important piece of legislation. Community pharmacies are important access points and his acknowledgment of this is truly appreciated."

Newsom's signing of Wiener's bill follows his veto last year of 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.

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