Friday, April 18, 2014 — 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.)