Newsom signs bill making HIV prevention meds available without prescription | The Hill

By Lauren Irwin

California Gov. Gavin Newsom (D) signed a bill Tuesday that makes medication preventing HIV available to residents without a prescription.

The bill, S.B. 339, authorizes pharmacists to furnish pre-exposure prophylaxis, commonly called PrEP, a drug that helps prevent HIV infection prior to exposure, as well as post-exposure prophylaxis, a drug used for patients exposed to HIV, if specified conditions are met.

The bill was introduced by state Sen. Scott Wiener (D) and will allow pharmacists to distribute the drugs without a prescription. Wiener said in a statement that while there have been “massive strides in HIV treatment,” the state still sees about 4,000 new infections each year, particularly in communities of color.

Source: Newsom signs bill making HIV prevention meds available without prescription | The Hill

Setting aside Lauren Irwin’s excusable ignorance of pharmaceuticals, PrEP (pre-exposure prophylaxis) being two drugs, emtricitabine and tenofovir, not one, she totally failed in her responsibility as a journalist to properly address the complexity of this ridiculous piece of NeoLiberal Democrat stupidity.

Promiscuous people, the highest risk among them for HIV and AIDS being, on a per capita basis, the radical LBGTQ+ community and IV drug addicts, have extremely poor judgement, personal accountability, and self-discipline. Often they suffer significant mental illnesses. I am going to divide this population of lost souls into two pragmatic groups. The INSURED and the UNINSURED.

THE UNINSURED

S.B. 339 makes no mention of the uninsured, the higher risk group of sexually promiscuous persons and IV drug users when compared to the insured. These are the people who use the emergency room for their medical care and never pay the bill. There is no where in S.B. 339 that provides for these more at risk persons. On a fundamental level, S.B. 339 does nothing to protect uninsured patients.

Fortunately, generic Truvada is a very affordable drug. While, depending on the pharmacy, generic Truvada (the trade name of PrEP) retails from $1,000 to $2,000 per month, no one ever pays those prices. No insurance company and no uninsured person. The high prices are, of course, completely fake as the drug costs the pharmacies $5-15 per month depending on their wholesale contract. The uninsured have easy access to drug discount programs like GOODRX that will drop the uninsured consumer cost to around $30 per month.

For at risk, uninsured drug addicts, the going street price for oxycodone is about $1 per milligram making it easy for an addict to burn through $100 a day or more to simply stave off withdrawal. As crazy as it sounds, impoverished, unemployed, and homeless drug addicts spend a crazy amount of money every year to feed their habit. They are not acquiring their fortune by using their good judgement and being responsible people. They beg, sell their bodies, and steal. The last thing they are concerned about is setting aside $30 a month to go their local pharmacy (which they steal from on a regular basis) to get their PrEP over the counter to protect themselves from HIV.

THE INSURED

Someone with health insurance who lives a high risk lifestyle, having sex with multiple partners, especially promiscuous homosexual men, are prone to a lot of sexually transmitted diseases, no different from the uninsured. Anal warts, herpes – genital and oral, thrush, the clap, the clam, hepatitis, tuberculosis, along with HIV and AIDS. The responsible thing for these persons to do is use their insurance and see a primary care provider regularly and do everything they can to protect themselves. They can get hepatitis B vaccines, HPV (human papillomavirus)vaccines, herpes prophylaxis, and HIV prophylaxis. They can wear condoms. They have these choices because they have insurance. Making PrEP OTC is not going to make irresponsible people take responsibility for themselves.

Only a NeoLiberal Democrat would come up with the idea of forcing an overworked, understaffed pharmacist to take responsibility for a high risk individual with insurance who is willfully shirking their personal responsibility for self-care. While a California pharmacist can pursue the Advanced Pharmacist Practitioner designation and order blood borne testing for patients, ordering, obtaining, and interpreting those results is a time consuming proposition. The presumption that a high risk person can walk into any random community Walgreens or CVS and the pharmacist will be properly trained and able to provide PrEP is unbelievable. They do not have the time or resources to do all that is required in the bill and then spend 30 minutes counseling a high risk person on the use of PrEP, needed lifestyle changes to reduce their risks, and then provide and bill insurance for PrEP. It is not in the scope of practice of a community pharmacist. Walgreens, CVS, and Rite Aid have tried and failed to roll out schemes like this for years and it always backfires. It is crap like this that is driving pharmacists to abandon the profession, just like I did.

DRUG INTERACTIONS and SIDE EFFECTS

Truvada has 133 major drug interactions, many of which are drugs that a high risk person could have cause to take. Drugs that treat herpes, anti-inflammatories like ibuprofen, drugs to treat tuberculosis, and oral treatments for yeast infections. It also has significant drug-disease interactions for people with liver or kidney disease.

Truvada has a lot of serious potential side effects. A lot of skin problems like blisters, lesions, burning sensations. It can also cause blindness.

Truvada also has two black box warnings, required safety alerts warning of extraordinary risks.

The first is for persons with hepatitis B viral infections affecting their livers. Discontinuing Truvada treatment in a person with active hepatitis B can cause an acute exacerbation of the infection.

The second is that Truvada should not be taken by patients who turn HIV positive because this leads to drug resistant HIV strains. The trouble is PrEP is only about 75% effective, meaning a high risk person who shoots up and has sex with any willing partner or partners could turn HIV positive at any time during treatment. How is a pharmacist who is filling 200 prescriptions a day going to give any sort of sponsorship or support to that individual?

THE TRUTH of the SHEAR STUPIDITY OF S.B. 339

Persons who engage in a high risk lifestyle, regardless of their circumstances, are at high risk for coinfections. They are at high risk for oral yeast infections. They are at high risk for hepatitis B and C. They are at high risk for herpes. They are at high risk for tuberculosis. They are at high risk for cirrhosis of the liver. And they are at high risk for having any combination of these all at the same time. The combined treatment for these diseases taken with Truvada could easily lead to kidney and liver failure simultaneously. Does this sound like a drug that should be available over the counter without the care and monitoring of a primary care provider?