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Governor McKee Signs Legislation Which Will Reduce the Spread of HIV Transmission

PROVIDENCE, RI Governor Dan McKee today signed into law legislation sponsored by Senator Melissa Murray that will help reduce the spread of HIV transmission by making HIV-prevention and post exposure medications accessible and covered by insurance, including newer injectable formulations. The Governor signed the legislation at Open Door Health and was joined by Senator Murray, state and local officials and community advocates.

"PREP and PEP are key tools to prevent the spread and help us work towards the eradication of HIV," said Governor Dan McKee. "However, this will only happen if we continue to break down barriers to access these critical medications. Thank you to all the advocates for raising their voices on this important issue and thank you to the General Assembly for sending this legislation to my desk for signature."

"Access to preventative medicine saves lives. Through this legislation, the state is leading the way in protecting Rhode Islanders' health care coverage against attacks on the Affordable Care Act," said Lieutenant Governor Sabina Matos. "Restoring and ensuring the continued affordability of PrEP and PEP is a positive step forward for public health, especially for the Black and Latino communities who are disproportionately affected by HIV."

"These treatments can reduce HIV transmission to almost zero," said Senator Murray (D-Dist. 24, Woonsocket, North Smithfield). "But because they are preventative, an at-risk patient with lower income may choose to prioritize other expenses, putting them at a much higher HIV risk. By reducing those high copayments and deductibles, we can help ensure patients get the treatment they need."

There are two commonly used HIV-prevention medications: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP is taken before an exposure to prevent HIV, whereas PEP is taken after a potential or known exposure. Together, the treatments have contributed to a dramatic reduction in HIV transmission rates [hiv.gov] in recent years. But only about 25 percent of individuals at risk of HIV transmission are using these treatments, according to the US Centers for Disease Control (CDC) [cdc.gov]. Advocates point to both out-of-pocket costs and lack of access as barriers.

The legislation (2023-S 0563Aaa [webserver.rilegislature.gov]) requires the coverage of PrEP and PEP drugs by health insurance plans at no out-of-pocket costs to patients. The bill would also enable pharmacists to prescribe them to eligible patients. The bill outlines clear guidelines for which patients would be eligible.

"The use of PrEP can substantially reduce the risk of HIV transmission, and PEP is an equally remarkable intervention for people who may have been exposed to HIV. However, these medications are underused, especially amongst people in groups with higher rates of HIV," said Interim Director of Health Utpala Bandy, MD, MPH. "This legislation is an important step toward ensuring equitable access to these critical medications, and consistent with our goal of giving Rhode Islanders in every community the tools and resources they need to stay healthy and safe."

"By mandating insurance coverage, limiting prior authorizations and reducing out-of-pocket costs for PrEP and PEP treatments, this law will expand access to these critical treatments and play a direct, significant role in helping Rhode Islanders proactively protect themselves against HIV," said Dr. Amy Nunn, executive director, Rhode Island Public Health Institute. "This is one of the most progressive public health policies in the country, and we applaud Governor McKee and the General Assembly for their leadership in getting it across the finish line."

"I've been prescribing PrEP for over 10 years. This bill overcomes a significant obstacle that many of my patients have mentioned including high out-of-pocket costs for the medication, " said Philip A. Chan, MD, an infectious diseases specialist and the Chief Medical Offer at Open Door Health. "Additionally, this bill covers injectable PrEP which is an important option for some people. The HIV epidemic is still impacting many people including cisgender gay and bisexual men. People should be aware of PrEP and talk to their medical provider about their potential HIV risk and whether PrEP may be an option for them."

CDC recommends that all adults test at least once for HIV in their lifetime and more frequently if engaging in behaviors that may place a person at ongoing risk of infection.

For people that may be at risk of HIV, PrEP is initiated before and continued throughout periods of potential exposure to HIV. It was first approved by the U.S. Food and Drug Administration in 2012 and is safe and highly effective when taken as prescribed. PEP is taken after a potential exposure, such as a broken condom, shared needle or sexual assault. If taken within 72 hours of a possible HIV exposure, the drug is highly effective at preventing transmission.

Both treatments are considered preventative, and free coverage had been required under the Affordable Care Act. But on March 30, in a case called Braidwood Management Inc. v. Becerra, U.S. District Judge Reed O'Connor ruled, among other things, that this requirement violated the religious freedom of employers. The case is expected to head to the U.S. Supreme Court.

A growing list of states including Maine, Nevada and Virginia have passed similar legislation.

RIDOH has additional information online about HIV prevention, including PrEP and PEP: https://health.ri.gov/diseases/hivaids/about/prevention/.

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