HIV continues to be a problem in Colorado and it is an issue of access. While the state has collectively decreased the number of newly reported HIV cases over the last few years, medically underserved communities across the state continue to see increases in new HIV cases. Simply put, HIV continues to be a growing issue in medically underserved communities because patients do not have access to providers who would otherwise be able to prescribe preventative medications. Colorado House Bill 20-1061, (HB 20-1061), provides a viable solution to this growing problem.
Giving pharmacists the ability to prescribe post-exposure and pre-exposure prophylaxis,
PEP and PrEP respectively, would allow for a drastic change in access to these medications, which is what HB20-1061 intends to do. PEP and PrEP are universally recognized as being an effective preventative drug that inhibits the spread of the HIV virus.
However, gaining timely and easily accessible access to these medications become crucial to their efficacy. If exposed to HIV the sooner a patient can gain access to post-exposure prophylaxis, the more effective the medication is, rendering itself completely ineffective after 72 hours post-exposure.
Thus, quick access to medication is crucial, but currently, is inaccessible, particularly in medically underserved communities such as Weld and El Paso County.
As a whole, Colorado has seen a decrease in new HIV infections. Over the past several years, the state has seen a decrease in new cases of HIV by one third, but this varies from county to county.
In particularly medically underserved communities, new HIV rates have not only decreased significantly less, but have actually increased. Weld and El Paso County are two examples of where the state has seen an increase in new HIV rates.
These counties have much higher rates of patients to providers, well exceeding the ratio threshold. Long wait times to see medical providers creates a barrier to accessing medications like PrEP and PEP.
Sigma around getting prescriptions to PrEP and PEP remains another barrier to access. Patients are hesitant to even seek out care because of the stigma associated with getting the prescription that is often affiliated with certain medical facilities. Pharmacies do not carry the same association, and thus the stigma, as other facilities might. Anyone can go into a pharmacy for a number of different reasons. Pharmacies are uniquely positioned to create a safe space for folks to get access to needed medication.
The bill further stipulates that insurance companies must provide coverage for these medications and cannot require a prior authorization or step therapy before covering the prescription. This further removes barriers and grants more access to care. Truvada, the leading PrEP medication on the market, can cost over $20,000 a year without insurance coverage.
Mandating that insurance cover the cost of these lifesaving medications opens up access to those seeking the medication without the infection prevention medications to patients, and, in connection therewith, making an appropriation hesitation or burden of cost. Furthermore, making sure that insurance companies do not create cost barriers also improves access to PEP that is most effective the sooner a patient is exposed to the HIV virus. Sciences is currently the only pharmaceutical company that manufactures HIV preventative Gilead medications. Their monopoly in this market and lack of competition allows them to charge an exorbitant amount of money for these medications.
This bill would not be Colorado’s first time in increasing a pharmacist’s scope and allowing them to write prescriptions. In 2016, the state voted to allow pharmacists to write birth control prescriptions for women. This was seen as a widely successful policy and was also targeted to give access to birth control in medically underserved communities. California enacted a similar bill to HB 20-1061 in October of 2019. The state has already seen the promise of opening the scope for pharmacists and other states are seeing this as a solution to a problem as well. This innovative solution to a complex problem of access could help eradicate the HIV infection epidemic in the state.
— Sara Robbins is a Healthcare Administrative Specialist and GSW Candidate for the University of Denver Health & Counseling Center