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HIV Drug Deserts

HIV Drug Deserts

HIV Drug Deserts

Prescription Drug Deserts

Ringgold County Iowa is a small farming community about 100 miles southwest of Des Moines.  With a population of about 5,500 people, it ranks as the second smallest population in the state. Most importantly, however, this small county is one of nine communities with almost no pharmaceutical presence. All 5,500 residents of the county are serviced by a single Hy-Vee pharmacy. The Hy-Vee pharmacy is currently run out of a small trailer in the parking lot of the store, but the residents of the county feel fortunate to have this option.

The Iowa Board of Pharmacy said that about 40 Iowa pharmacies have closed between 2017 and 2019. The executive director of the Board, Andrew Funk, notes that the largest contributing factor to the rash of closings are the industry middlemen, Pharmacy Benefit Managers (PBMs). According to Funk, “Essentially, the PBMs say, ‘This is how we’ll reimburse you – take it or leave it.”

Currently, the Iowa Board of Pharmacy is searching for a solution, but the trend of closing pharmacies and “prescription drug deserts,” or, communities which are not serviced by a pharmacy, is showing no signs of changing soon.

California: PrEP/PEP without Prescription

The United States FDA first approved Truvada® for pre-exposure prophylaxis, or PrEP, in 2012. The approval was based on studies showing that individuals who took the medication daily dramatically reduced their chances of HIV infection from either an HIV-positive person, or from intravenous drug use. Since that time, the practice has grown in prevalence, but only with the supervision of a medical professional. Typically, if a person had been exposed to HIV, they would contact a doctor, who would order a prescription to be filled and supervised by a pharmacist.

California Senator Scott Wiener signed Senate Bill 159 into law on October 21, which allows pharmacists to dispense 28-day supplies of PrEP without a prescription. This law also covers PEP, or post-exposure prophylaxis, for individuals who have already been exposed to HIV. Most importantly, this law bars insurance companies from requiring prior authorization before PrEP/PEP medications are provided. The law’s advocates feel that the time saved by immediately going to a pharmacy is critical in prevention and treatment. The California Health Benefit Review Program, an independent group that provides analysis of medical, financial, and public health benefits of legislation, estimates that the bill will result in over 700 people getting access to the anti-HIV medications, leading to about 25 fewer cases of HIV transmission in the first year of the law’s implementation.

References:

  • Prescription Drug Deserts
    • https://www.kcci.com/article/as-pharmacies-dwindle-10-iowa-counties-left-in-prescription-drug-desert/29504116 (accessed 10/25)
    • https://www.pharmacist.com/article/pharmacies-dwindle-multiple-counties-left-prescription-drug-desert (accessed 10/25)
    • https://ce.naco.org/?county_info=19159 (accessed 10/25)
  • PrEP/PEP without Prescription
    • https://www.npr.org/2019/10/08/768313666/california-to-make-hiv-prevention-drugs-available-without-a-prescription (accessed 10/25)
    • http://chbrp.org/about_chbrp/index.php (accessed 10/25)
    • https://www.latimes.com/california/story/2019-10-07/over-the-counter-hiv-prevention-drugs-access-prep-pep-california (accessed 10/25)
    • https://www.gilead.com/news-and-press/press-room/press-releases/2012/7/us-food-and-drug-administration-approves-gileads-truvada-for-reducing-the-risk-of-acquiring-hiv (accessed 10/25)
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