Three leading California AIDS organizations --
AIDS Project Los Angeles, the
L.A. Gay & Lesbian Center and
Project Inform in San Francisco -- today
applauded California’s Medi-Cal program for easing access to a well-established AIDS medication that has been proven to prevent HIV infection in at risk individuals.
The
action lifts a requirement that doctors complete an authorization
request when prescribing PrEP for HIV negative individuals. PrEP is the
brand drug Truvada, an AIDS drug manufactured by Gilead Sciences in
Foster City, CA. The action is effective immediately and will be
published in Medi-Cal’s June Provider Bulletin.
Many in the
HIV/AIDS community consider PrEP a groundbreaking HIV prevention tool.
The authorization request is considered an obstacle for both doctors
and patients. With Medi-Cal’s action, doctors will now be able to
prescribe the drug for men and women who test HIV negative and indicate
that they are “at risk” of infection through HIV exposure.
“The
Medi-Cal ruling is a game changer in HIV prevention,” said AIDS Project
Los Angeles Executive Director Craig E. Thompson. “Appropriate access
to PrEP through Medi-Cal provides us with another intervention – along
with safer sex and condom use – to reduce the number of new HIV
infections.”
“Medi-Cal’s action also brings an element of health
equity to the program’s low-income beneficiaries,” Thompson said.
“Private insurance plans have been covering PrEP for some time, often
without prior authorization.”
"Project Inform and other
organizations working directly with people at risk of acquiring HIV have
conjectured that the slow uptake of PrEP may be more attributable to
clinicians' reluctance to provide sexual health services of this type
than to patients' lack of knowledge of PrEP or willingness to take it,”
said Project Inform’s Executive Director Dana Van Gorder. “Lifting the
TAR removes a potential obstacle that may have contributed to providers’
reluctance to prescribe PrEP."
Research modeling shows Truvada
may be up to 99 percent effective in preventing new infections,
depending on adherence and whether the drug is used in conjunction with
safer sex counseling, provision of condoms and other prevention
services.
“By making it easier for people at-risk of HIV
infection to get access to medicine that has been proven to prevent HIV
infection, California has set an important precedent for the rest of the
nation,” said L.A. Gay & Lesbian Center Chief of Staff Darrel
Cummings. “This collaboration between Medi-Cal and community advocates
will move California closer to the comprehensive response that is needed
to help end the HIV epidemic.”
The policy change resulted from
discussions with Medi-Cal’s Pharmacy Policy Branch Chief, Mike Wofford,
his staff and representatives from APLA, the L.A. Gay & Lesbian
Center and Project Inform. The discussions focused on provider knowledge
of PrEP, possible side effects associated with long-term use of
Truvada, and community acceptance of the intervention.
Previously,
Medi-Cal patients asking for Truvada could have been asked to meet
several conditions outlined in the TAR for “high risk” individuals. Some
of these conditions could have required the provision of condoms and
monthly HIV testing – not necessarily real world conditions.
“There
is a reason the AIDS community is talking about ending the epidemic,”
Thompson said. “We have three successful medical interventions to
reduce new infections, including PrEP. What we need now is broad
community and provider education on these interventions to increase
acceptance and utilization.”
The three interventions include:
PrEP for at risk HIV negative individuals, post-exposure prophylaxis or
PEP for people who know or suspect they have been exposed to HIV, and
HIV anti-retroviral treatment as prevention (TasP) for those living with
HIV (HIV/AIDS drugs can bring viral load -- the amount of virus in the
body -- down to undetectable levels in people who are HIV positive,
reducing the likelihood that they will be able to transmit the virus to
sexual partners).
