A week after one HIV prevention bill stalled in the California Legislature, a second bill focused on ending transmission of the disease and other sexually transmitted infections in the Golden State now awaits a decision by Governor Gavin Newsom to either sign it into law or veto it. It comes amid a federal legal fight over employers being required to pay for such preventive services in the health care coverage for their employees.
Assembly Bill 1645, authored by gay Assemblymember Rick Chavez Zbur (D-Santa Monica/West Hollywood), would close loopholes and strengthen protections in existing law to ensure that California health insurers continue to provide free and complete coverage for preventive services like PrEP, an effective medicine for ensuring people remain HIV-negative, and testing for STIs. As of January 1, 2024, large group policies issued or renewed by health insurers would not be able to require copays for such services or screenings if the bill becomes law.
Individual or small group health care service plan contracts or health insurance policies as of January 1, 2025, would not be able to impose cost-sharing requirements, utilization review, or other specified limits on a recommended STI screening and other preventive services under the bill. Violating the bill's provisions would constitute a criminal offense.
On Wednesday, the Assembly passed AB 1645 by a 64-8 vote with eight abstentions. The Senate had adopted the legislation September 12 by a 31-7 vote with two abstentions. Newsom has until October 14 to sign it.
"All Californians deserve access to life-saving preventive care without worrying about hidden fees and costs," stated Zbur. "Creating an affordable and accessible pathway to this care, which includes STI and HIV testing and treatment, will be a tremendous benefit to overlooked communities who have traditionally lacked access to these important services, including young people, people of color, LGBTQ+ people, and more."
So proud to see that AB 1645 — Enhanced Consumer Protections for Preventive Care — has passed out of the Senate. Thank you, @SenSusanEggman, for presenting on the Senate Floor! And thank you to our sponsors @ICRicardoLara, @APLAHealth, @SFAIDSFound, @LALGBTCenter & @eqca! #caleg pic.twitter.com/b2VEugUoXQ
— Assemblymember Rick Chavez Zbur (@AsmRickZbur) September 12, 2023
Federal case
The bill comes amid federal litigation filed by Christian business owners who contend they should not have to pay for certain health care, such as PrEP, in the insurance policies they offer to employees. Their lawsuit, Braidwood Management v. Becerra, specifically targets the requirement in the Affordable Care Act that most private insurance plans cover recommended preventive care services without cost sharing.
In March, a lower court judge struck down part of the ACA's requirement for no cost coverage of preventive services recommended or updated by the U.S. Preventive Services Task Force since March 23, 2010 and also ruled that the plaintiffs can cite their religious beliefs for refusing to cover PrEP. The U.S. Justice Department appealed the decision in May, and the 5th U.S. Circuit Court of Appeals stayed the district court's ruling as it considers the matter.
A legislative analysis of Zbur's AB 1645 noted advocates of the bill contend "it will strengthen existing law in the face of these incessant judicial attacks on the ACA and ensure that health plans cover the full spectrum of preventive services without cost sharing, including office visits and other necessary health care services for delivering a preventive benefit."
The Legislature's passage of AB 1645 comes after gay state Senator Scott Wiener (D-San Francisco) last week pulled his Senate Bill 339 aimed at expanding access to PrEP after the Assembly Appropriations Committee inserted language into it he considered to be a "poison pill amendment." The bill had sought to increase the amount of PrEP that pharmacists are authorized to provide without a doctor's prescription.
It also would have required health plans to reimburse pharmacists for PrEP services. It built 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.
Yet the amendments made to his bill allowing insurance companies to impose prior authorization and step-therapy for PrEP and PEP, which are significantly limited under existing law and regulations, would result in reducing patient protections, contended Wiener. Unless there is a legislative path forward to remove the amendments so it can be taken up again next year by state lawmakers, Wiener said he would abandon the bill.
While the California Pharmacists Association said the amended bill still allowed pharmacists to independently initiate and provide PrEP/PEP, it supported Wiener's decision to reexamine the legislation since it removed protections for patients.
"Our commitment is to do what is in the best interest of patients, it is at the heart of what we do," stated Michael Conner, president of the professional group. "Therefore, we cannot support moving the bill forward at this time. We look forward to working together to move a bill that meets the intention of improving access to these life-saving medications."
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