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Assembly committee advances bill to require pharmacy‑benefit coverage for injectable PrEP
Summary
The Assembly Health Committee advanced SB 1023, which would require insurers that cover long‑acting injectable PrEP under a medical benefit also to provide coverage through pharmacy benefits, a change proponents say will reduce administrative barriers for providers and increase timely access for patients.
Senator Laird told the Assembly Health Committee on June 9 that SB 1023 would expand access to long‑acting injectable HIV pre‑exposure prophylaxis (PrEP) by requiring commercial insurers that reimburse injectable PrEP through a medical benefit also to cover it through a pharmacy benefit. The bill was presented as a way to simplify billing and speed reimbursement so providers are not forced to purchase and store expensive medications while waiting for payment.
"PrEP is one of our most powerful tools for preventing HIV transmission," said Jonathan Froxwieck of the San Francisco AIDS Foundation. He told the committee that clinics sometimes wait an average of 26 days for reimbursement for injectable PrEP and that some providers must decline to offer injections to commercially insured patients when plans limit reimbursement to medical‑benefit pathways.
The bill drew broad support from HIV‑care and public‑health organizations, including the San Francisco AIDS Foundation, Equality California, the Los Angeles LGBT Center and a roster of clinical and advocacy groups that signed on as supporters.
Representatives of health‑plan trade associations urged caution. Cassidy Heckman of the California Association of Health Plans told the committee the industry believes PrEP and post‑exposure prophylaxis (PEP) are already widely covered and that the bill risks ‘‘directing plans on how to structure their benefits’’ rather than addressing coverage. Matt Akin of the Association of California Life and Health Insurance Companies said that, in general, prescription drug benefits are intended for self‑administered medicines while medical benefits cover provider‑administered drugs; he argued the bill would blur that line and constrain benefit design.
Senator Laird and witnesses acknowledged those concerns and said they would continue negotiations with insurers while urging committee approval. "We want to serve the purpose of lowering HIV transmission and making sure there's good prevention," the author said.
The committee recorded a motion and second to send SB 1023 to the Appropriations Committee.
What happens next: SB 1023 will go to the Assembly Appropriations Committee for further consideration. If it advances there it may proceed to floor and, if passed, to the governor for signature.
