California’s Medi-Cal program has made it easier for low-income people to get access to Truvada, a drug believed to reduce the risk of contracting HIV, by eliminating requirements that those people be provided with condoms and be tested monthly for HIV and that their doctors seek Medi-Cal’s permission before writing a prescription.
The decision was applauded by AIDS Project Los Angeles, the L.A. Gay & Lesbian Center and Project Inform in San Francisco — three of the state’s leading organizations focused on HIV education and prevention.
Truvada is manufactured by Gilead Sciences and is used as part of a program called pre-exposure prophylaxis (PrEP) that is intended to reduce the chance that a person will become infected with HIV by requiring him to take certain steps before engaging in sex. Those steps include taking the drug daily and using a condom when engaging in anal or vaginal sex
“The Medi-Cal ruling is a game changer in HIV prevention,” said Craig E. Thompson, APLA’s executive director. “Appropriate access to PrEP through Medi-Cal provides us with another intervention – along with safer sex and condom use – to reduce the number of new HIV infections.”
“Medi-Cal’s action also brings an element of health equity to the program’s low-income beneficiaries,” Thompson said. “Private insurance plans have been covering PrEP for some time, often without prior authorization.” Medi-Cal is a state welfare program serving low-income families, seniors, persons with disabilities, children in foster care, pregnant women, and certain low-income adults.
Research shows Truvada may be up to 99 percent effective in preventing new HIV infections if it is taken daily as prescribed and used in conjunction with safer sex counseling, provision of condoms and other prevention services, stipulations that drove the previous Medi-Cal requirement for condoms and HIV testing for those at high risk of contracting HIV.
Monthly HIV testing is a way to determine whether someone who has been taking Truvada inconsistently has become infected with HIV as a result. If someone is infected with HIV and doesn’t take an anti-retroviral drug such as Truvada every day, the HIV virus in his system may become resistant to the drug.
The policy change resulted from discussions with Mike Wofford, Medi-Cal’s pharmacy policy branch chief, and representatives from APLA, the L.A. Gay & Lesbian Center and Project Inform. The discussions focused on how well doctors were informed about Truvada, possible side effects associated with long-term use of Truvada such as kidney and bone damage and and community acceptance of Truvada as an tool to help prevent HIV infection. A press release from APLA, the LA Gay & Lesbian Center and Project Inform said requiring regular HIV tests and the provision of condoms were “not necessarily real world conditions.”