R.I. General Assembly passes legislation to help expedite access to HIV prevention meds

Seen here is a generic version of Truvada, a combination of two older antiretroviral drugs, tenofovir and emtricitabine. Truvada was the first PrEP drug approved in the U.S. It’s taken orally once daily. (Alexander Castro/Rhode Island Current)

Prescription drugs that prevent HIV could become easier to access in Rhode Island after the General Assembly OK’d legislation Tuesday eliminating out-of-pocket costs and insurance obstacles.

Complementary bills by Rep. Rebecca Kislak, a Providence Democrat and Sen. Melissa Murray, a Woonsocket Democrat, remove the possibility of prior authorization for the preventative drugs collectively known as PrEP (pre-exposure prophylaxis). They build on Murray’s legislation , which took effect Jan. 1, 2024, and guaranteed coverage to eligible patients for these drugs. Prior authorization is an approval process used by health insurance companies that can delay the continuation or start of certain treatments.

Murray said in a statement Tuesday that PrEP and PEP are “the most effective tools to prevent transmission globally…This is why there is such a critical need to ensure no-cost, swift access. Otherwise, we risk sacrificing the progress made in combating the HIV epidemic over the past 30 years.”

When taken as directed, PrEP has high rates of preventing HIV; commonly cited figures show a 99% lower chance of contracting HIV from unprotected sex. Injection drug use sees a 74% reduction in HIV contraction. A more recent intervention called PEP, is used within 72 hours of possible HIV exposure, not only from unprotected sex but also in workplace settings, where health care providers might come in contact with HIV-positive blood. Both drugs are used by sexually active people, especially men who have sex with men or people who have multiple sex partners.

According to 2022 data from the federal Centers for Disease Control and Prevention, PrEP was prescribed to 36% of people who might benefit from it. The CDC wants to see that number increased to 50% by 2025. But in May, the CDC announced it needed to retool its PrEP surveillance data, as past years’ numbers may have been erroneous. The CDC expects it will release new data on PrEP coverage nationwide in June 2025.

Data from the Rhode Island Department of Health suggests the impact an increasing array of HIV medications — a group comprised largely of antiretroviral drugs — has had on the once much-deadlier virus. Since 2008, the number of new HIV infections in the state has dropped by about half, and more people are living HIV-positive because available medications prevent the virus from advancing to the more aggressive AIDS.

A year’s worth of generic, daily PrEP in pill form cost about $360 in 2022. But the new legislation could also save the health care system money by preventing the need for costlier HIV treatments. A 2022 report from the HIV+Hepatitis Policy Institute estimated that, over 10 years, PrEP could prevent enough infections to save $2.27 billion in patient treatment costs.

The legislation encountered some resistance from the insurance industry. Testimony submitted to the House Committee on Health and Human Services by Prime Therapeutics, the pharmacy benefit manager used by Blue Cross Blue Shield of Rhode Island, argued that “removing the ability to have utilization management tools in place puts patients at risk.”

That criticism didn’t persuade lawmakers, who see the drugs as a public health issue. Kislak, in a statement, underlined the import of an affordable way to prevent an illness that, while more treatable than in decades past, can still change one’s life.

“This legislation is an important step forward in preventive care and will make sure that no one faces roadblocks to protecting themselves from HIV,” Kislak said in a statement. “PrEP and PEP are incredible tools that are saving lives from a virus that devastated a generation, and the critical importance of access to them cannot be overstated.”

The bill now goes to Gov. Dan McKee. Olivia DaRocha, a spokesperson for the governor’s office, said Wednesday that the bill was still being reviewed. No update was immediately available Thursday afternoon.

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