The summer of 2021 marked a time of great achievement in expanding the role of pharmacists. During the last three months, lawmakers, associations, and advocates from all across the country fought to give pharmacists more rights and responsibilities. With their persistence, pharmacists received more authority to prescribe, dispense, and treat patients than ever before 一 and it was only the beginning.
Of all of the laws that were in session this summer, though, some of the most important were those relating to the prevention and treatment of HIV. A number of states passed bills allowing pharmacists to care for HIV-exposed or HIV-positive people.
In effect, these laws have increased pharmacists’ responsibilities, generated traction for provider status, and brought relief to the over 1 million Americans currently diagnosed with HIV. With the help of pharmacists 一 along with two key medications 一 HIV patients can expect better outcomes, with fewer complications.
In October 2019, California became the first state to authorize pharmacists to treat HIV patients using PEP and PreP. Under SB 159, California pharmacists were given jurisdiction to prescribe these medications without collaborative practice agreements.
PEP, or post-exposure prophylaxis, is an emergency medication available to people recently exposed to HIV. If taken within 72 hours, PEP reduces the risk of HIV infection by more than 80%. PreP, or pre-exposure prophylaxis, on the other hand, is available to those who are at a greater risk of HIV exposure but who have not yet been exposed. PreP is a preventive medication that, if taken as prescribed, reduces the risk of HIV by 99%.
Previously, California pharmacists were only permitted to dispense PEP and PreP under a provider’s supervision 一 but SB 159 eliminated the extra step and gave pharmacists the ability to prescribe independently.
Since California, a number of other states have created legislation regarding PEP and PreP. Many states have started the process, but this summer, four states saw it to completion.
Leading off this summer’s efforts was Nevada’s SB 325. On June 6, Governor Steve Sisolak enacted the bill to fight the state’s rising HIV rates.
Currently, Nevada has the fifth-highest rate of HIV infection in the country, with over 10,000 diagnosed residents. Prior to SB 325, only 1,500 Nevadans had taken advantage of PEP and PreP. Governor Sisolak is hopeful, though, that the new bill will improve access to treatment and increase those numbers.
During a hearing of the bill, Sisolak remarked, “We all know that this health crisis has shown us, without a doubt, that we do not have enough doctors out there to help individuals. What this bill seeks to do is allow pharmacists to kind of step in and help out, especially in the realm of dealing with pre-exposure to immunodeficiency and also to post-exposure.”
In effect, SB 325 will allow pharmacists to protect their patients and expand their scope of practice at the same time 一 a win for both parties.
After Nevada, two states passed their own HIV legislation; and they did it just one day apart from one another.
Missouri made the first move on June 22, when Governor Mike Parson signed HB 476 into law. HB 476 grants pharmacists the ability to administer both PEP and PreP in emergency situations, according to guidelines from the CDC.
Sponsors of the bill felt that, in the wake of COVID-19, HIV treatment was largely forgotten. HB 476 aims to get it back on track. Missouri Senator Greg Razer says, “Missouri is now on the frontline of ending the last great pandemic… A lot of people look at COVID and before that the flu of 1918, but people tend to forget about HIV and AIDS. There are two ways of ending this pandemic: One way is to find a cure, which seems to be far off, and the other is to get everyone who is currently positive to an undetectable status where they can no longer transmit the virus. This is the way to do that.”
Only 24 hours after Missouri, Governor Kate Brown approved Oregon’s SB 2958-B. The bill was designed to help the more than 7,000 people in the state who live with HIV via PEP and PreP. It has a special focus on access in underserved communities.
Rep. Dacia Grayber, a sponsor of the bill, celebrated its passing by saying, “[SB 2958-B] is about reducing barriers to access for life-saving medications... PrEP and PEP are both vital parts of the toolkit for ending the HIV epidemic. By empowering pharmacists to test for HIV and prescribe these medications, we make it easier for Oregonians to get the health care services they need.”
In the final days of summer, North Carolina joined the movement. On August 20, Governor Roy Cooper signed HB 96 into law. HB 96 is an all-encompassing bill that allows pharmacists to dispense more medications 一 particularly injectable medications 一 but it also authorizes PEP dispensing.
Lee Storrow, Executive Director of the North Carolina AIDS Action Network, said, “People who need post-exposure prophylaxis are finding themselves in an emergency situation, and they need to get access to the medication in up to 72 hours…There’s strong agreement from even medical providers that pharmacists need to be able to dispense this medication to folks.” With HB 96 in place, Storrow believes that HIV infection and transmission rates will decrease dramatically.
Along with its PEP provisions, HB 96 also allows pharmacists to prescribe birth control and administer testosterone injections to patients 18 and older.
Over the past three months, each of these states 一 Nevada, Missouri, Oregon, and North Carolina 一 have made tremendous achievements for the practice of pharmacy. They have set an example for expanding PEP PreP laws and HIV protection in all states. More broadly, though, they have demonstrated the ability of pharmacists to identify and solve problems in their communities with precision and skill. These four states pave the way for change, but your pharmacy can keep it moving forward.
Contact your legislators, support your state’s bills, and get active 一 not only in expanding HIV treatment but also in claiming provider status. Change is coming, and your pharmacy can be a part of it.
To get the latest updates on laws like these, and to find out what’s happening in your state, visit PioneerRx’s newest resource, Pharmacy Laws and Regulations. We provide relevant, regularly updated content to help your pharmacy stay ahead of the curve.