California lawmakers are working to make PrEP and PEP available as over-the-counter drugs without a prescription, reports Capital Public Radio.
PrEP, pre-exposure prophylaxis, is the once-a-day treatment using Truvada that has been proven to be more than 90% effective in preventing HIV infection.
PEP, post-exposure prophylaxis, is prescribed to patients who have experienced possible exposure to HIV. Taken within 72 hours of exposure, the 28-day course of HIV medications is meant to stave off infection before the virus can take hold in the patient’s system.
Both PrEP and PEP currently require a prescription from a physician. Often, a patient’s insurance company has to sign off on the prescription before coverage kicks in.
California state Sen. Scott Weiner of San Francisco wants to change that. He is the lead author of Senate Bill 159.
The legislation would authorize pharmacists to provide PrEP and PEP without a prescription, much like birth control pills are currently available in the Golden State.
Under SB 159, Patients would have to be tested for HIV within the seven day period before buying the medication, and pharmacists would have to notify a patient’s primary physician as well as counsel the patient on side effects.
The measure passed in the state Senate in May by a vote of 34-1, and it is now working its way through the state Assembly where Assemblymember Todd Gloria is sponsoring the bill.
Equality California has made the bill a top priority. Additionally, the legislation is supported by the San Francisco AIDS Foundation, APLA Health, the Los Angeles LGBT Center, and the California Pharmacists Association.
But the California Medical Association wants to see changes made before the bill becomes law.
Specifically, the CMA wants the PrEP component removed from the bill, and only supports allowing a portion of PEP to be dispensed by a pharmacist before a doctor would prescribe the remaining treatment.
The CMA points to possible drug interactions as well as complications with kidney or liver functions that could occur if dispensed without regular checkups and screening.
In a letter to lawmakers, Morgan Carvajal, legislative advocate for the CMA’s Center for Government Relations, wrote, “Prescribing a daily, long-term use, medication of strong HIV regimen drugs to healthy, HIV-negative patients demands a high degree of safety and consideration that is only achieved safely by the patient-physician relationship.”
There’s no word as yet regarding pricing of the medications under SB 159.
It is important to note there is an error in the original article that pharmacists initiating and furnishing PrEP is not the equivalent to providing the medication ‘over the counter’. Only the U.S. Food & Drug Administration can classify medications, and the current PrEP medications are not classified as over the counter. The pharmacist must provide a health assessment to the patient and conduct an HIV test to ensure they are clinically eligible (per CDC guidelines) to receive the medication. Then, after providing the medication to the patient, the pharmacist must document the visit in the medical chart and notify the patient’s primary care provider of the visit, if permitted by the patient. This new law is a very important step in expanding access to PrEP medication, but doing so in a manner than ensures patient safety. Portraying the medication as over the counter is inaccurate and misleading since patients cannot simply walk into a pharmacy and pick it up off the shelf themselves. We have emailed the author at Capitol Public Radio of this error but it has not been corrected.