PrEP and PEP Treatments Now Available in California Pharmacies

HIV prevention drugs will be available for purchase as an over-the counter medication in all California pharmacies starting Wednesday, making the state the first to do so in the U.S., LGBTQ advocates said.

California Senate Bill 159 expands access to “life-saving HIV prevention medication” by authorizing pharmacists to “furnish at least a 30-day supply–and up to 60-day supply–of pre-exposure prophylaxis [PrEP] and a complete course of post-exposure prophylaxis [PEP] without a physician’s prescription,” said Samuel Garrett-Pate in an October press release from Equality California, the nation’s largest statewide LGBTQ civil rights organization.

PrEP is a daily medicine taken by people at-risk for developing HIV in order to prevent infection, according to the Centers for Disease Control and Prevention. On the other hand, PEP is an emergency treatment that, if started within 72 hours of potential HIV exposure, can prevent infection, the CDC said.

Prior to the July 1 implementation of SB 159, any person seeking PrEP or PEP needed to obtain a prescription from a doctor or nurse practitioner, either in the emergency room or at the doctor’s office, said Courtney Mulhern-Pearson, vice president of policy at the San Francisco AIDS Foundation. Since PEP needs to be started within a short timeframe of exposure, “it can be hard to get a prescription,” she said.

“Anytime can be hard to get in with your doctor within that time frame, but especially if the event happened after hours or on the weekend,” Mulhern-Pearson said. “It can be hard to be able to find somebody who can see you within 72 hours.”

Hopefully, the law will “expand the access point for PEP and PrEP” and spread “awareness of [the drugs] as an intervention that’s available to folks,” Mulhern-Pearson said.

“There’s stigma attached with HIV still and with PEP in general,” Mulhern-Pearson said. “There’s doctors who often won’t talk to their patients about PEP and patients who don’t ask their doctors about PEP as much as they probably should.”

There’s also stigma around sexual behaviors that can lead to HIV, Mulhern-Pearson said.
“We have heard of doctors refusing certain side tests for their clients even when the client did ask for it and telling them to use condoms,” Mulhern-Pearson said.

The fractured conversation between doctors and their patients results in a “lack of offering” and builds “barriers that need to be overcome,” Mulhern-Pearson said.

“We’re just trying to chip away at as many barriers as we can to make PEP and PrEP more accessible,” Mulhern-Pearson said.

Bringing pharmacists, who are “trusted community health providers,” into the PEP and PrEP conversation “increases the number of people who are helping spread awareness” and “offers a lower threshold access point” for people to obtain the medications in a “timely manner,” Mulhern-Pearson said.

“I think having a sign up in a pharmacy that says, ‘Ask me about PEP’ normalizes PEP as something to talk to your provider about,” Mulhern-Pearson said.

PrEP and PEP are expensive treatments that range in cost from $2,000 for monthly PrEP medication to $1,000 for PEP administration, according to the International Association of AIDS Providers. Financial roadblocks to accessing PrEP and PEP are a “major barrier for people living in an expensive city like San Francisco,” said Debora Holtz in an April news release for the San Francisco AIDS Foundation.

Those who make below 500% of federal poverty level, which is $63,000 in San Francisco, can qualify for the AIDS Drugs Assistance and Preexposure Prophylaxis Assistance programs, better known as ADAP and PrEP-AP, sponsored by the California Department of Public Health, the department said. Though ADAP typically covers the cost of prescription medication, it will, “as payor of last resort,” provide “coverage for the PEP medication for those individuals that have no other health care coverage and are enrolled into the PrEP-AP program,” CDPH said.

As for private insurance companies, the new law removes “the requirement that people obtain preauthorization” for PEP, a previous roadblock for seeking the treatment, Holtz said. Private insurance is also expected to cover PrEP and PEP treatments, Mulhern-Pearson said.

SB 159 “technically” went into effect on January 1, but because the California State Board of Pharmacy requires “drafting implementation guidelines” and development of a training course, “the implementation of the pharmacists’ piece was pushed to July 1,” Mulhern-Pearson said.

Due to pandemic, there were concerns over a delayed implementation of the law, Mulhern-Pearson said. However, the Board of Pharmacy did adopt “an emergency regulation” on April 30 that “specifies the requirements for training courses pharmacists must complete before they can initiate and furnish HIV PrEP and PEP,” said Bob Dávila, public information officer for the board.