California pharmacists face barriers to offer HIV medications

California Senate Bill 159 authorized pharmacists to prescribe HIV pre-exposure (PrEP) and post-exposure (PEP) medications without an outside provider’s prescription in order to increase access to HIV preventative medications. However, a new study led by  UC Berkeley School of Public Health Epidemiology Professor Sandra McCoy found that just 11% of California pharmacists surveyed had prescribed the medications since the bill’s introduction nearly three years ago.

The study, done as part of the California HIV/AIDS Policy Research Centers in collaboration with the Center on Reproductive Health, Law and Policy at UCLA, surveyed about 900 California pharmacists and pharmacy students  in Fall 2022  about their knowledge and implementation of HIV prevention services. An overwhelming majority had never furnished PrEP or PEP services and only 72% had heard of SB 159. Less than half of respondents felt confident in their ability to prescribe PrEP, and less than a third reported receiving the training to deliver the services.

“We found that most pharmacists value their role in providing essential sexual and reproductive health services, but many face policy and organizational barriers to implementing them in practice,” said Lauren Hunter ‘21, Berkeley Public Health alum and lead researcher on the study. “Addressing these challenges is necessary to pave the way for widespread access to high-quality HIV prevention and birth control services in community pharmacies.”

Significant advancements have been made in HIV prevention and treatment over the past two decades. PrEP is a pill taken once daily for HIV-negative people that substantially reduces risk of infection. PEP is a once-daily pill taken for 30 days after HIV exposure. When taken correctly and as quickly as possible after exposure, PEP can stop infection.

About 5,000 Californians become infected with HIV each year and access to care is difficult for many, particularly gay and bisexual men of color and transgender people. PrEP and PEP are key components of the state’s strategy to combat the epidemic, although a 2018 study found that only 4% of sexually active gay and bisexual men used these highly-effective strategies. SB 159 as well as 2021’s Senate Bill 409, which allows pharmacists to provide the HIV testing required to administer PrEP and PEP services, were enacted to make services and mediation easier to access.

The research team’s findings showcase the complicated realities of policy implementation. The pharmacists surveyed frequently cited insufficient staff and time as an obstacle to providing HIV services, as well as lack of insurance coverage for their services (eligibility assessment, consultation), even when the medication is covered, and perceived low demand for PrEP and PEP. “Implementation continues to lag” despite lowered barriers, the study notes, thereby “hindering efforts to prevent HIV.”

The California legislature introduced Senate Bill 339 in February to address some of these issues. If passed, the bill will ensure pharmacies are reimbursed for their services and extend the 60-day supply to 90 days for PrEP and PEP, each concerns the report recommended that future policies enact.

Authors include Sandra McCoy, Lauren Hunter, Laura Packel, Pooja Chitle, and Amanda Mazur of UC Berkeley School of Public Health; Raiza Beltran, Ayako Miyashita Ochoa, Ian W. Holloway of UCLA Luskin School of Public Affairs; Kerith J. Conron and Cathren Cohen of UCLA School of Law Williams Institute. The study was conducted by the California HIV/AIDS Policy Research Centers and funded by the California HIV/AIDS Research Program.