Senate approves bill clearing barriers to HIV prevention prescriptions
STATE HOUSE – Building upon legislation enacted last year to require insurance coverage of the HIV prevention medications PrEP and PEP, the Senate today approved legislation sponsored by Sen. Melissa A. Murray to prohibit out-of-pocket costs and prior authorization for them.
The legislation (2024-S 2255) is intended to remove barriers to patient access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), two extremely effective HIV prevention medications.
“We know that PrEP and PEP are up to 99% effective at preventing transmission of HIV when taken as directed and have been one of the most effective tools to prevent transmission globally,” said Senator Murray (D-Dist. 24, Woonsocket, North Smithfield), who also sponsored the bill enacted last year. “This is why there is such a critical need to ensure no-cost, swift access. Otherwise, we risk sacrificing the progress made in combating the HIV epidemic over the past 30 years. This bill helps to ensure people who are at high risk for HIV can access the preventive care they need to remain HIV negative and live full and healthy lives.”
The bill, which now goes to the House of Representatives, would prohibit insurers from requiring patients to get prior authorization from the insurer before a PEP or PrEP prescription can be dispensed, or from requiring step therapy – a series of other therapies the patient must try before the prescription is approved. It would also prohibit insurers from requiring copayments or subjecting the drugs to deductibles, or refusing to pay for prescriptions dispensed at an out-of-network pharmacy.
Dr. Phil Chan, chief medical officer at Open Door Health in Providence, testified during the bill’s hearing before the Senate Health and Human Services Committee that prior authorization requirements are often barriers to patient access, often resulting in delays lasting several days. Since PEP needs to be taken within 72 hours of exposure to be optimally effective, prior authorization requirements pose a particular danger for those in need of it. And some patients, when required to make a return trip to the pharmacy days later to pick up the prescription, abandon it altogether, leaving themselves at risk.
“Every hour and day when a prescription is held up by something like a prior authorization really has detrimental effects on HIV outcomes,” said Dr. Chan.
Out-of-pocket costs also contribute to prescription abandonment and increased infection, Dr. Chan said, adding that co-pays of $10 or $20 can be a real barrier for the populations that are most affected by HIV.
A study of more than 58,000 patients with new prescriptions for the drugs found that, after a year, HIV infection rates were two to three times higher among patients who abandoned the prescription because of the costs. Even costs as low as $10 were found to increase the abandonment rate.
The legislation now goes to the House, where Rep. Rebecca Kislak (D-Dist. 4, Providence) is sponsoring companion legislation (2024-H 7625).
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