The Louisiana Legislature Can Expand Access to HIV Prevention Medications

The Louisiana State Legislature is considering a bill that would allow pharmacists to prescribe medications that prevent human immunodeficiency virus (HIV) infection directly to patients. HB579 directs Louisiana’s Board of Pharmacy to implement a statewide protocol that enables pharmacists to provide initial prescriptions for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) without involving other medical providers. Expanding pharmacists’ scope of practice to include direct prescribing is a growing trend for PrEP, PEP, and other medications to address access issues and meet consumer demand. HB579 signals that Louisiana is serious about reducing the burden of HIV on the state.

In 2021, Louisiana had one of the highest rates of new HIV diagnoses in the country, with 903 newly documented infections. It is important to promote prevention because, although people living with HIV can lead full lives, the virus is not curable. PrEP and PEP are highly effective medications that reduce a person’s risk of HIV infection when taken properly. Unfortunately, these medications are underutilized— especially in Louisiana, where only an estimated 25 percent of people who could benefit from PrEP have received a prescription. While there are many barriers keeping the other 75 percent from using PrEP, access to providers is one systemic hurdle that smart policies like HB579 can help address.

Pharmacies are some of the most accessible health care facilities for the majority of Americans, with 88.9 percent living within five miles of a pharmacy. A 2023 study showed how integrating pharmacies into the HIV prevention landscape could increase PrEP access points in southeastern states. It found that if residents could access PrEP through pharmacies, the number of PrEP-prescribing locations would increase 80.9-fold. This is particularly important because the study evaluated PrEP access in Ending the HIV Epidemic (EHE) priority jurisdictions—select counties and states where greater than 50 percent of new HIV diagnoses occurred from 2016 to 2017. Louisiana is home to two EHE priority jurisdictions: East Baton Rouge Parish and Orleans Parish. These two metropolitan areas accounted for 46 percent of new HIV diagnoses in Louisiana in 2021.

Not only are pharmacies a convenient access point for consumers, pharmacists support becoming PrEP prescribers. A survey of South Carolina pharmacists found that 86 percent would be willing to prescribe PrEP to clients. Ensuring that patients remain engaged with care is also important, and trials comparing physician-led to pharmacist-led PrEP-prescribing clinics have found similar patient retention rates for both models. Consumers are also open to getting PrEP prescribed from their pharmacists. A survey of men who have sex with men in Atlanta found that about 61 percent were willing to be screened for PrEP in a pharmacy. In another survey of Arizonans, all respondents agreed that allowing pharmacists to prescribe PrEP would benefit the community.

Louisiana legislators made some wise decisions in crafting HB579. First, it stipulates that pharmacists can bill a client’s insurance for their services and be reimbursed at the same rate as other health care providers. This is an important addition to any bill authorizing expanded pharmacy-based services, since pharmacists have little incentive to offer new services without it. Additionally, HB579 allows the state’s Board of Pharmacy sufficient latitude to write a comprehensive and evidence-based protocol that relies on expertise rather than politics.

Preventing new HIV infections benefits both individuals and communities. Whether to improve health or decrease health care costs, expanding access to PrEP and PEP makes sense. HB579 is an example of how smart policy can benefit consumers and public health.