California Just Made a Historic Move In PrEP and PEP Expansion

After passing almost unanimously in the California State Legislature, a bill aimed at expanding access to the life-saving drugs pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) has been signed into law by Governor Gavin Newsom.

"The HIV epidemic is still a pressing issue today -- especially for LGBTQ people of color and folks in rural communities," Rick Zbur, executive director of Equality California which was a co-sponsor of the bill, said in a statement. "But with Governor Newsom's signature, [Senate Bill] 159 is a giant step forward in getting to zero transmissions, zero deaths and zero stigma.

PrEP is a pill-based regimen, most commonly implemented with Truvada, that almost entirely negates the possibility of HIV transmission through sex. PEP is a course of antiretroviral medicines, started within 72 hours after possible exposure to HIV that can help prevent a patient from seroconverting.

The bill, which goes into effect January 1, 2020 and was written by Senator Scott Wiener and Assemblymember Todd Gloria, makes California the first state to allow pharmacists to provide both medications without a physician's prescription. It is also the latest step that puts California ahead of other regions when it comes to the fight against HIV and AIDS.

"By increasing access to life-saving HIV prevention medication, California -- unlike the White House -- is leading the country in the race to eliminate HIV," Zbur added. "We owe a debt of gratitude to Senator Wiener and Assemblymember Gloria for their leadership and tireless advocacy."

With the assistance of Equality California, here's an explanation of exactly what this bill does.

Does SB159 make PrEP and PEP over-the-counter drugs?

Not really. While this bill does mean that those who would like to go on the drugs don't have to go to a physician and pay the fees associated with a doctor's visit, there are still requirements they must meet. Those wishing to go on PrEP must still have a recent HIV test result, confirming they are negative, and will need to undergo a screening with a pharmacist to ensure there are no signs they have HIV. This, in addition to counseling around the drug, are all required before you can begin taking PrEP

*Note: Out previously stated in coverage this bill would make these regimens over-the-counter drugs. That verbiage has been updated.

What exactly does the bill do?

This bill is a multi-pronged approach. Firstly, it makes PrEP available without a prescription. This means that for those that find a primary care visit cost prohibitive, the legislation allows them to try PrEP from 30 to 60 days without fronting the cost to see their primary physicians -- if they have one. As a representative from Equality California notes to Out, "every hour counts" for PEP. The drug is supposed to be taken within 72 hours after a possible exposure so the bill would not only erase the cost for a hospital visit, but allow those in need of the medication to access it quickly.

Lastly, the bill makes pre-authorization -- a lengthy process by which insurance companies may require additional paperwork for specific drugs -- illegal for all antiretrovirals including PrEP and PEP.

Is this an option for long-term use?

While this bill will mean that a full course of PEP is available now at the localpharmacist without a prescription, those who would like to continue on PrEP beyond the 30 to 60 day supply will need to see a physician. During this time, they will also be able to get routine, recommended screenings including STI screenings as well as kidney function screenings that come with taking Truvada. But Equality California believes that this will still cause some who hadn't been on the drug previously to get on it.

"We've found that once people get on PrEP, they are more likely to stay on it," a representative says. And this bill will go a long way in lowering the barriers for that initial step.

What are the prices?

While the bill will drastically lower medication prices by way of removing copays associated with an initial doctors visit, it will not affect the cost of purchasing PrEP, which is covered by most insurance plans in the state of California.