Nationwide, Nevada has one of the highest HIV diagnoses with 16.6 positive diagnoses per 100,000 people. With one of the highest rates of diagnoses in the country, Nevada is becoming one of the first states allowing pharmacists to prescribe HIV prevention drugs to those patients at risk of contracting the virus.
On June 6, 2021, Governor Steve Sisolak signed a bill authorizing pharmacists to prescribe and administer HIV prevention drugs, beginning October 1, 2021, which includes post and pre-exposure prophylaxis, without a prescription. Patients will now be able to walk into a pharmacy, speak with a pharmacist about HIV and their risk, and obtain medication to reduce their risk.
When a person is infected with HIV, they have it for life. The human body is unable to fight off the virus, it can however be controlled and the progression of the disease can be slowed. Over the past 10 years, the Food and Drug Administration (FDA) has approved drug therapies for those at risk of becoming infected, including Truvada and Descovy. Truvada can reduce the risk of infection and is recommended for all adults and adolescents at risk through either sex or injection drug use. Descovy is recommended for a smaller group of people and is being evaluated for effectiveness in preventing infection through vaginal sex.
Expanding access to options for prevention, especially since there are not enough doctors available to help individuals, is important in supporting the LGBTQ+ community of Nevada and providing health care across the state.
Pharmacists can assist patients in dealing with pre-exposure to immunodeficiency and post-exposure. The hope is that this wide-reaching public health effort will help to reduce the high transmission rate in the state. The ease of access in getting the medication from a neighborhood pharmacy will eliminate not only the stigma of first going to a primary care provider but also provide the crucial 72-hour window of early treatment.
The bill requires the State Board of Pharmacy to develop protocols for pharmacists to also conduct or order laboratory tests to determine whether the medication is appropriate, ultimately leading to a quicker turnaround in treatment. It’s important that the regulations and protocols being developed as well as the insurance liability does not prevent a pharmacist from administering the medication, so the State Board will hold public hearings to gather feedback.
A concern, in reducing the cases of HIV, will be the high cost of the medication. Insurance and federal and state programs can help reduce costs but the bill, SB325, requires that public and private health care plans cover the cost of the medication, the costs of laboratory and diagnostic procedures, and reimbursing pharmacists for testing and prescribing in the same manner as primary care providers are reimbursed.
Most people are unaware of the financial options available for patients with HIV. Gilead, the pharmaceutical company that manufactures Truvada and Descovy, has a program – Advancing Access – that provides coupon cards to patients who are eligible for financial assistance for their copays. They also announced plans to donate Truvada annually to the CDC for uninsured Americans at risk for HIV through 2030. The Department of Health and Human Services has a program – Ready, Set, PrEP – for patients without prescription drug coverage to obtain PrEP at no cost. And, pharmacists may also be unaware of these options.