California Governor Gavin Newsom has signed a bill allowing HIV prevention and post-exposure medication to be sold without prescription in the state, making it easier for people to access. The new law will allow pharmacists to dispense two types of HIV-prevention drugs without it being ordered by a doctor, the first US state to do so.
From January 1, when the legislation goes into effect, it will be possible for people to get hold of preexposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) drugs. The bill authorizes pharmacists – who have completed a board-approved training problem – to dispense the drugs to people that meet clinical criteria. The law also stops insurance companies from requiring patients to get prior authorization before using their insurance to get the drugs.
“The HIV epidemic is still a pressing issue today – especially for LGBTQ people of color and folks in rural communities," executive director of LGBTQ civil rights organization Equality California, Rick Zbur, said in a statement. "But with Governor Newsom’s signature, SB 159 is a giant step forward in getting to zero transmissions, zero deaths, and zero stigma. By increasing access to life-saving HIV prevention medication, California – unlike the White House — is leading the country in the race to eliminate HIV."
PEP is a course of antiretroviral medicine taken after potential exposure to HIV to prevent infection, used in emergency situations such as a condom breaking during sex with someone who has or may have HIV, needles shared between drug users, or cases of sexual assault. PEP started within 72 hours after possible exposure is pretty effective, though not 100 percent according to the Centers for Disease Control and Prevention (CDC).
PrEP is a combination of two medicines (tenofovir and emtricitabine) taken daily by people at very high risk of HIV infection, and is highly effective when used correctly.
"PrEP reduces the risk of getting HIV from sex by about 99% when taken daily," according to the CDC website. "Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74% when taken daily."
Around 29,400 people in California use PrEP, according to the California Health Benefits Review Program, which provided analysis for the legislature, whilst just over 6,000 people use PEP. Legislators hope the change will reduce the number of people contracting HIV by removing barriers to access the drugs, and reducing the stigma around them.
The California Medical Association was initially opposed to the bill out of concerns of “long-term use without physician oversight,” The Washington Post reports, but dropped their stance and remained neutral after the bill was amended to limit the number of PrEP pills you can buy without a physicians note to 60 days' worth, at which point patients will have to see a medical professional to obtain more.
Though the legislation is welcomed by many, the cost will still be prohibitive for some. Truvada, the PrEP drug, costs between $8,000 and $14,000 per year according to the New York State Department of Health. In Australia, the same drug costs around AUS$474 (US$320) per year. PEP costs between $600 and $1,000 a course.