Pre- and post-exposure prophylactics, including medications like Descovy, are used to help prevent HIV infection. (photo by Jorge Soler)

California State Senate Bill 339 was intended by Sen. Scott Wiener (D-San Francisco) to be a game-changer for access to pre- and post-exposure prophylactics, but now Wiener has put a pause on the bill, citing the insertion of what his office termed a “harmful amendment.”

While the initial bill was designed to help pharmacists furnish PrEP and PEP to patients, cutting down on prescription and insurance red-tape necessary to access the medication, Weiner’s office said the amendment would have allowed for “insurance companies to impose prior authorization and step-therapy.”

The amendment was added by the Assembly Appropriations Committee. Dr. Tyler TerMeer, the CEO of the San Francisco AIDS Foundation, said that the amendment’s insertion has reversed “years of advocacy for HIV prevention in California.”

“What they did is they introduced an amendment, with the committee staff being in agreement … and they put the … pre-authorization [in the bill], which is what we were trying to avoid, because we want people to have an easier access to PrEP, which is proven to save people from becoming HIV infected,” West Hollywood governmental affairs liaison Hernan Molina said.

“It’s heartbreaking to see a straightforward, critically important HIV prevention bill stall this way,” Wiener said. “Thousands of Californians contract HIV each year, and we need common sense measures like SB 339 to improve access to PrEP.”

While nonprofit organizations like the Los Angeles LGBT Center make access to the potentially life-saving drugs possible, there are still medical and sociological factors that can prevent access in areas outside of LGBTQ-bastions like West Hollywood.

“While the current version of the bill meets the goal of CPhA to allow pharmacists to independently initiate and provide PrEP/PEP, it removes protections for patients,” said Michael Conner, president of the California Pharmacists Association. “Our commitment is to do what is in the best interest of patients, it is at the heart of what we do. Therefore, we cannot support moving the bill forward at this time.”

California has made movements in the past to expand access to PrEP, including passing Senate Bill 159 in 2019, which allowed pharmacists to provide a 60-day PrEP supply without a prescription. This bill, however, still had obstacles in terms of insurance coverage and the need for a primary-care physician referral within the 60-day window. Nevada, Utah and Colorado have all passed legislation that does not limit a pharmacist on the distribution of HIV-preventative medication.

West Hollywood Mayor Pro Tempore John Erickson, who also works at Planned Parenthood, said that prior authorization is the most difficult obstacle to getting people the medication. He also said the blame for the amendment lies squarely on one California assemblyman’s shoulders.

“That committee staff does not just do stuff on their own,” Erickson said. “They do it with the exclusive sign-off of the committee chair, who is Assemblyman Chris Holden (D-Pasadena). And so essentially what that assembly member did in appropriations is kill access to life-saving preventative medication for individuals who are trying to prevent themselves from getting HIV. That is mostly people of color, poor people, immigrants and, sadly now if you look at numbers, it’s Black and brown women. And so, a Democrat in a powerful position [is] essentially [sentencing] people to potential death sentences or life sentences with a disease that is treatable and doesn’t have to happen.”

Erickson added that with California’s Democratic supermajority, the bill would have easily passed both houses without the additional amendment.

“It’s shameful. And I don’t care what anyone says, because I know how Sacramento works … Chris Holden did this to this bill. And he is directly responsible whether or not he was directly asked by the health insurance companies to do it. He is the chair of the committee; he could have stopped it. And he knew that this would further undermine this bill and access to PrEP,” Erickson said.

Now that the bill is on pause, Weiner will have to reintroduce it again later, sans the amendment, and the timetable for the bill’s passage could take years.

“Now we have to reintroduce a bill in January, get an emergency rule order, which I think is probably out of the question, or make it into a two-year bill. And then that puts the coalitions at a disadvantage, because now we have to start all over again,” Erickson said.

Holden is running for Los Angeles County Supervisor, 5th District, in 2024, looking to unseat incumbent Kathryn Barger, the lone Republican on the five-member board.

“I’m going to work like a dog to make sure [every] voter in his district … knows that they could have had better access to care if it weren’t for him,” Erickson said.

Holden’s office did not respond to a request for comment by deadline.