Only a few exceptions exist to the rule that a pharmacist must dispense pursuant to a valid prescription. Such exceptions are: furnishing emergency contraceptives, hormonal contraceptives, and naloxone hydrochloride. Beginning next year, pharmacists in California also will be able to dispense HIV prevention drugs without prescriptions.

Senate Bill 159 authorizes pharmacists to furnish a 30-day supply and up to a 60-day supply of drugs used for pre-exposure  or post-exposure prophylazis (PrEP) without requiring a prescription from the patient, as long as the following conditions are met:

• The patient is HIV negative;
• The patient does not report any signs or symptoms of acute HIV infection;
• The patient does not report taking any contraindicated medications;
• The pharmacist provides counseling to the patient on the ongoing use of preexposure prophylaxis;
• The pharmacist does not furnish more than a 60-day supply of preexposure prophylaxis to a single patient more than once every two years, unless directed otherwise by a prescriber.

In addition, pharmacists dispensing PrEP without prescriptions must complete a training program approved by the Board of Pharmacy.

This bill also expands the Medi-Cal schedule of benefits to include PrEP as covered pharmacist services.

Another interesting highlight of the bill: the plans and insurers would be prohibited from subjecting antiretroviral drugs, including PrEP to prior authorization or step therapy (with some exceptions) and PBMs could not deny coverage for PrEP. The bill also prohibits plans and insurers from covering PrEP that has been furnished by a pharmacist in excess of specified amounts.