A study from UC Berkeley’s School of Public Health found that few California pharmacists are prescribing HIV medications without an ordered prescription, even though California law allows them to do so.
Senate Bill 159, or SB 159, permits pharmacists in California to prescribe post-exposure prophylaxis, or PEP, as well as 60 days of preexposure prophylaxis, or PrEP, for the use of HIV prevention to individuals without a prescription, according to Sandra McCoy, professor in residence in the campus division of epidemiology.
“Despite SB 159’s adoption three years ago, implementation continues to lag despite pharmacists’ belief that the provision of HIV prevention in the pharmacy is important and their willingness to provide HIV prevention services,” McCoy said in an email.
A survey McCoy’s group conducted found that from a pool of 900 California pharmacists, 96% felt pharmacy-based PEP and PrEP provision is vital. Yet 11% of the surveyed respondents had actually initiated PrEP provision at their pharmacies and only 13% did so for PEP.
Application barriers found in the study were that 53% of pharmacists noted that there wasn’t adequate time set aside for PrEP services, and one in six mentioned that not having “pharmacy-based” PrEP services be covered by insurance is an inhibiting factor to its usage, according to McCoy. Overall, 37% of interviewees from pharmacies that do not initiate PrEP said the main issue is that there is insufficient time dedicated to training pharmacists on its implementation.
“PrEP is a highly effective tool to prevent HIV. Unfortunately, many people who could benefit from PrEP are not able to access it,” McCoy said in the email. “Pharmacies could be a convenient and non-stigmatizing PrEP and PEP access point for many people, as pharmacies are available in most communities and pharmacists are trained to offer expert advice and provide essential health products and services.”
Furthermore, only 29% of licensed pharmacists in current practices said they have had training on PEP and PrEP. McCoy said this issue could be remedied by expanding and improving the marketing of training programs. She added that many of these existing problems could be solved through the adoption of Sen. Scott Wiener’s new Senate Bill 399.
An additional obstacle for the use of PrEP is that 42% of interviewees felt that the 60-day limit established through the bill is not an adequate amount of time to successfully refer people to a primary care physician in order to continue their usage of PrEP, McCoy added.
“In this way, once implementation barriers are addressed, PrEP and PEP delivery through pharmacies has the potential to expand the reach of these highly effective yet underutilized HIV prevention tools to help California achieve its goals for HIV prevention,” McCoy said in the email.