New law clears barriers to HIV prevention prescriptions

 

STATE HOUSE – A new law sponsored by Rep. Rebecca Kislak and Sen. Melissa A. Murray will prohibit prior authorization requirements and out-of-pocket costs for the HIV prevention medications PrEP and PEP.

The new law, which takes effect on health insurance policies issued or renewed in Rhode Island beginning Jan. 1, 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.”

Said Representative Kislak (D-Dist. 4, Providence), “This legislation is an important step forward in preventive care and will make sure that no one faces roadblocks to protecting themselves from HIV. PrEP and PEP are incredible tools that are saving lives from a virus that devastated a generation, and the critical importance of access to them cannot be overstated. Prevention is the key to making sure we never move backward in the fight against HIV.”

The new law (2024-H 7625A, 2024-S 2255), which builds upon another PrEP/PEP access bill enacted last year, prohibits 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 also prohibits 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 hearings 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.

 

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