Murray bill to reduce HIV transmission
passes General Assembly
STATE HOUSE – The General Assembly has passed legislation by Sen. Melissa A. Murray to make HIV-prevention medications free and accessible to qualifying patients.
There are two commonly used HIV-prevention treatments: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Together, the treatments have contributed to a dramatic reduction in HIV transmission rates in recent years. But only about 25% of individuals at risk of HIV transmission are using these treatments, according to the US Centers for Disease Control (CDC). Advocates point to both costs and access as barriers.
“These treatments can reduce HIV transmission to almost zero,” said Senator Murray (D-Dist. 24, Woonsocket, North Smithfield). “But because they are preventative, an at-risk patient with lower income may choose to prioritize other expenses, putting them at a much higher HIV risk. By reducing those high copayments and deductibles, we can help ensure patients get the treatment they need.”
Approximately 1.2 million Americans are living with HIV, which can be spread through exposure to certain bodily fluids from individuals who have HIV and a detectible viral load. If left untreated, HIV can lead to acquired immunodeficiency syndrome (AIDS), a chronic, potentially life-threatening condition.
PrEP is initiated before and continued throughout periods of potential exposure to HIV. It was first approved by the U.S. Food and Drug Administration in 2012 and is safe and highly effective when taken as prescribed.
PEP is taken after a potential exposure, such as a broken condom, shared needle or sexual assault. If taken within 72 hours of a possible HIV exposure, the drug is highly effective at preventing transmission.
Both treatments are considered preventative, and free coverage had been required under the Affordable Care Act. But on March 30, in a case called Braidwood Management Inc. v. Becerra, U.S. District Judge Reed O’Connor ruled, among other things, that this requirement violated the religious freedom of employers. The case is expected to head to the U.S. Supreme Court.
The legislation (2023-S 0563Aaa) would require the coverage of these drugs by health insurance plans at no out-of-pocket costs to patients. The bill would also enable pharmacists to prescribe them to eligible patients. The bill outlines clear guidelines for which patients would be eligible.
Under current law, both treatments must be prescribed by a doctor, physician’s assistant or nurse practitioner. But as Rhode Island struggles to find primary care providers, pharmacies could help fill in the gap. Studies show that pharmacist provision of PrEP is well received by patients, according to the AIDS Education and Training Center. Pharmacists are often trusted by the communities in which they work and pharmacies have convenient locations and flexible hours.
A growing list of states including Maine, Nevada and Virginia have passed similar legislation. The CDC has set a national goal of reducing HIV transmissions by 90% from 2019 levels by 2030. Making PrEP and PEP widely available and utilized is a key part of that goal.
The bill now heads to the governor’s desk for his signature.
