CA Pharmacy PrEP: AB317 Passed!
California pharmacy reimbursement legislation expected to improve pharmacists’ ability to provide PrEP!
by Maria Lopez, PharmD (CBA Specialist & President of Mission Wellness Pharmacy)
AB 317 paves the way for pharmacists’ reimbursement for services offered by a pharmacist that are within the scope of practice. AB 317 should greatly aid expansion of HIV prevention services by California pharmacists. AB317 requires insurers that offer coverage for a service that is within scope of practice of a duly licensed pharmacists to pay or reimburse for those services. Although SB159 was passed into law in 2019, pharmacists have experienced barriers with providing HIV prevention services such as PrEP and PEP due to lack of reimbursement for those services. On a national level, the Centers for Medicare and Medicaid Services (CMS) does not recognize pharmacists as providers and therefore the majority of insurers do not pay for pharmacists services.
In 2016, California passed legislation (AB1114) to mandate the Medicaid program (Medi-Cal) reimburse for pharmacists services authorized under SB493 (including: naloxone, immunizations, contraception, smoking cessation, travel medication). However, reimbursement has been limited to Medi-Cal. Interestingly, a larger number of payors, but not all, have since included vaccinations. AB317 should greatly aid expansion of all services within a pharmacists scope of practice. In particular, AB317 should help ease the barrier California pharmacists face with lack of reimbursement for HIV prevention services and aid expansion of HIV prevention services in California at accessible pharmacy locations.
Specifically AB317 requires “a health care service plan and certain disability insurers that offer coverage for a service that is within the scope of practice of a duly licensed pharmacist to pay or reimburse the cost of services performed by a pharmacist at an in-network pharmacy or by a pharmacist at an out-of-network pharmacy if the health care service plan or insurer has an out-of-network pharmacy benefit.” The bill imposes a state mandated local program and reads “a violation of the bill’s requirements relative to health care service plans would be a crime.” The legislation can be viewed here.
References:
- AB317 Legislation bill. Available at: https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB317
- Gardiner D. Gavin Newsom signs bill to make anti HIV drug available without prescription. Available at: https://www.sfchronicle.com/politics/article/Gavin-Newsom-signs-bill-to-make-anti-HIV-drug-14499337.php.
- Bellman R, et al. An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies. 2022;62:370-377.
- CPHA Announces Payment for Services Legislation. Available at this link.
