Testimony in Support of Pharmacist Prescribing of HIV Infection Prevention Drugs in Florida
Testimony from:
Chelsea Boyd, Research Fellow, R Street Institute
In SUPPORT of HB 159: “An Act Relating to HIV Infection Prevention Drugs”
February 15, 2024
House Health and Human Services Committee
Chair Randy Fine and Committee Members:
Thank you for considering my testimony. My name is Chelsea Boyd; I conduct research about integrated harm reduction for the R Street Institute, a nonprofit, nonpartisan public policy research organization. Our mission is to engage in policy research and outreach to promote free markets and limited, effective government in many areas, including harm reduction and sexual health. This is why HB 159 is of special interest to us.
In 2021, 3,700 Floridians found out they have HIV.[1] Over the five-year period starting in 2017, HIV diagnoses in Florida decreased by about 16 percent.[2] Nevertheless, the estimated lifetime cost of one person getting HIV ranges from $326,411 to $490,095 (discounted) in 2019 dollars or $873,402 to $1,205,248 (undiscounted), which presents a significant societal burden in addition to the human costs.[3]
The creation and growing use of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent HIV infections have helped many people decrease their risk of getting HIV. When taken as prescribed, PrEP is 99 percent effective at preventing HIV infection from a sexual encounter and 74 percent effective for preventing HIV infection from injection drug use.[4] Although the number of people who could benefit from using PrEP and have received a prescription for the medication has been increasing, many people who could benefit from using PrEP have not received prescriptions.[5] In Florida, it is estimated that only 37 percent of people who could benefit from using PrEP had been prescribed the medication in 2022.[6] This is particularly concerning because Florida is home to seven of the 48 priority counties identified as geographic hotspots for HIV infection in the Department of Health and Human Services’ 2019 Ending the HIV Epidemic in the U.S. plan, which aims to end the HIV epidemic by 2030.[7] The 48 priority counties, plus Washington, D.C., and San Juan, Puerto Rico accounted to more than 50 percent of new HIV diagnoses from 2016 to 2017.[8]
Decreasing HIV diagnoses requires a holistic approach that integrates communities and their leaders, healthcare providers, governing bodies, and individuals.[9] Increasing access to PrEP and PEP is one strategy that policymakers can influence directly. Passing legislation, like H 159, that allows pharmacists to prescribe PrEP and PEP directly to patients is one policy that is gaining traction across the country.
As of September 2023, 17 states had passed legislation that gives pharmacists authority to prescribe PrEP and/or PEP.[10] As the U.S. grapples with a predicted shortage of up to 124,000 physicians by 2034, it is vital that policymakers explore ways to utilize all healthcare providers fully.[11] Pharmacists have doctorial level training in pharmacology, therapeutics, clinical problem solving, medication use, and laboratory monitoring, yet research has shown that they are underutilized.[12] This is particularly unfortunate given that pharmacies are often the most easily accessible health care location.[13]
HB 159 offers Florida an additional strategy for preventing HIV infections and improving the health of Floridians. By instructing the state medical boards to produce a statewide protocol, legislators are authorizing the experts at these organizations the freedom to develop a procedure that follows professional best practices and prevailing healthcare standards. This latitude is the strength of HB 159. One thing to consider with this bill is how pharmacists will be reimbursed for providing PrEP and PEP services. Without specifying how insurance providers must cover pharmacist-provided services, pharmacists have no guarantee that they will receive payment for services rendered, creating a disincentive to offer these services.[14] NASTAD (National Alliance of State and Territorial AIDS Directors) recommends, “Statutes should explicitly outline the PrEP and PEP-related services health insurance providers must cover. Additionally, statutes should either define pharmacists as providers or require equitable reimbursement rates between pharmacists and PCPs.”[15]
In summary, allowing pharmacists to prescribe HIV prevention medications is an important component of ending the HIV epidemic in Florida and the U.S. For this reason, it is critical that the Legislature pass HB 159.
Chelsea Boyd, M.S.
Research Fellow
R Street Institute
(202) 922-6826
[email protected]
[1] U.S. Health and Human Services, America’s HIV Epidemic Analysis Dashboard (AHEAD), August 18, 2019. https://ahead.hiv.gov/?location=10.
[2] Ibid.
[3] Adrienna Bingham et al. “Estimated Lifetime HIV-Related Medical Costs in the United States.” Sexually Transmitted Diseases 48:4 (2021) pp. 299-304. https://pubmed.ncbi.nlm.nih.gov/33492100/.
[4] Centers for Disease Control and Prevention, “PrEP Effectiveness,” June 6, 2022. https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html.
[5] Centers for Disease Control and Prevention, “PrEP for HIV Prevention in the U.S.,” September 29, 2023. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html.
[6] U.S. Health and Human Services, America’s HIV Epidemic Analysis Dashboard (AHEAD), August 18, 2019. https://ahead.hiv.gov/?location=10&indicator=283&measure=rate.
[7] U.S. Health and Human Services, “EHE Overview,” December 4, 2023. https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/.
[8] Ibid.
[9] Ibid.
[10] Sonya Collins, “Pharmacists Expand Access to PrEP in 17 States,” PharmacyToday 29:9 (September 2023). https://www.pharmacist.com/Publications/Pharmacy-Today/Article/pharmacists-expand-access-to-prep-in-17-states.
[11] Andis Robeznieks, “Doctor shortages are here—and they’ll get worse if we don’t act fast,” AMA, April 13, 2022. https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act.
[12] Jennifer Kibicho et al., “Are community-based pharmacists underused in the care of persons living with HIV? A need for structural and policy changes,” Journal of the American Pharmacists Association 55:1 (2015) pp. 19-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858315/.
[13] Lucas A. Berenbrok et al., “Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis,” Journal of the American Pharmacists Association 62:6 (November-December 2022) pp. 1816-1822.e2. https://www.sciencedirect.com/science/article/pii/S1544319122002333.
[14] NASTAD, “Pharmacist Authority to Initiate PrEP & PEP and Participate in Collaborative Practice Agreements.” https://nastad.org/sites/default/files/2023-08/PDF-Pharmacist-Authority-Initiate-PrEP-PEP.pdf.
[15] Ibid.