Though the inquiries around Gilead’s exorbitant prices for Truvada have reached even the House Committee on Oversight and Reform, elsewhere some legislators are pushing for easier access to PrEP, for which the drug is used. In California, a bill is circulating that would make PrEP and PEP over the counter drugs, available without a prescription.
PrEP is pre-exposure prophylaxis, a system of treatment that involves a one a day pill to prevent being infected with HIV. While the CDC has only approved this in a process where the pill is taken once a day, PrEP 2-1-1, or “on demand” PrEP is picking up traction, most recently with the World Health Organization signing on — California also led this implementation stateside with San Francisco integrating 211 into their guidelines in February, while New York did so last month. Both are recommended for usage with a condom as neither protects against other STIs.
PEP is post-exposure prophylaxis, where a patient takes a short course of HIV medications within 72 hours after a possible exposure to the system. This is meant for emergency situations.
Currently both medications require prescriptions, and in some cases, require prior authorization where a doctor must get approval from insurance companies before writing the prescription. That would go out of the window as well with the bill under consideration reports Capital Public Radio.
The changes would come as a result of the passing of Senate Bill 159, of which Senator Scott Wiener from San Francisco, is the lead author. Todd Gloria, an assemblyman from San Diego is a co-author and Equality California took the bill on as a priority and it passed in the Senate with an almost unanimous vote. San Francisco AIDS Foundation is also a co-sponsor.
Making the drugs available over the counter would circumvent sometimes dicey conversations with providers as well as providers who may be opposed to or unaware of the medication, which effectively nullifies the possible transmission of HIV through intercourse when used properly. In this new iteration, patients would need to be tested for HIV within the seven days prior to purchasing and would be counseled by pharmacists on the side effects and other pertinent information. Pharmacists would also have to notify the patient’s primary care provider and could give patients up to a 30-day supply of the medications. What the price on the drug would be as an over-the-counter option is not yet known. But not everyone is in favor.
The California Medical Association said that giving out PrEP “demands a high degree of safety and consideration that cannot be achieved at a pharmacy.” Generally before prescribing PrEP — and even while on it — patients have their liver and kidney functions tested as there may be side effects. The Association would like the bill revised so that only PEP is available over the counter according to Bay Area Reporter.