PrEP without a prescription now a reality in California

California, the nation's most populous state, just enacted a new law ensuring more access to pre-exposure prophylaxis, or PrEP, which is nearly 100 percent effective at preventing HIV transmission.

SB 339, introduced by pioneering gay state senator Scott Weiner, was signed on Tuesday by Democratic governor Gavin Newsom. Five years ago, California passed a similar law increasing access to PrEP, but leaders and health officials believed it did not go far enough in improving access to the medication, especially among Black and brown men who have sex with men and other marginalized groups.

"The [2019] legislation authorized pharmacies to furnish up to a 60-day supply of PrEP without a prescription. It also banned health plans from imposing step therapy and prior authorization on PrEP," according to a statement from Wiener's office. "However, few pharmacies have successfully used the law to furnish PrEP in California. In surveys, providers cited the fact that health plans do not cover the cost of pharmacists’ labor in preparing PrEP as a major obstacle, and that the 60-day window is too short to ensure referral to a primary-care physician."

The new bill aims to fix the prior's loopholes and cut down the state's HIV cases — the state sees about 4,000 new infections annually. SB 339 requires health plans cover up to a 90-day supply of PrEP prescribed by a pharmacist, and an ongoing supply if the patient is ensured follow-up care and testing. To encourage drug stores to opt-in, SB 339 also requires health plans to cover costs associated with pharmacist services when distributing PrEP, including testing services.

"These measures will remove the most significant reported barriers to making PrEP available without a prescription," Wiener's office states.

SB 339 also allows pharmacists to dispense PEP, post-exposure prophylaxis, without a prescription. PEP can stop HIV transmission for those exposed to HIV within the past 72 hours.

“PrEP and PEP prevent thousands of new HIV infections every year, but they are still far too difficult to access,” Equality California Executive Director Tony Hoang said in a statement. “SB 339 will make it easier for California pharmacists to provide these important medications without a doctor’s prescription and bring the state one step closer to the ending the HIV epidemic. We were proud to partner with the California Pharmacists Association and San Francisco AIDS Foundation on this important bill, and we are grateful to Senator Wiener for his ongoing leadership on this issue.”

States like Colorado, Nevada, and even Utah have also moved to make PrEP available without a doctor's prescription and remove barriers that discourage pharmacists from taking part in dispensing the medication.

“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, “Michael Connor, PharmD, MBA, President of the California Pharmacists Association, said in a statement. “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.”