BILL ANALYSIS Ó
AB 2640
Page 1
Date of Hearing: May 4, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2640 (Gipson) - As Amended April 21, 2016
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill requires, after a patient known to be at high risk for
human immunodeficiency virus (HIV) infection tests negative for
HIV, the medical provider or the person who administers the test
to provide written information about the effectiveness and
AB 2640
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safety of all methods that prevent or reduce the risk of
contracting HIV, including, but not limited to, preexposure
prophylaxes (PrEP) and postexposure prophylaxes (PEP),
consistent with guidance of the federal Centers for Disease
Control and Prevention (CDC).
FISCAL EFFECT:
1)To the extent this bill raises awareness of drug therapy for
people at high risk for HIV, this bill could potentially
increase demand for and utilization of drug treatment for HIV
prevention, particularly PrEP. According to the New York
State Department of Health, Truvada, the drug used in PrEP
therapy, costs between $8,000 and $14,000 per year. Medi-Cal
prices for the drug are unknown, but even assuming significant
discounts are available, costs to Medi-Cal could be in the
millions annually if even a few hundreds more people a year
take the medication (GF/federal). PrEP must be taken every
day while the person remains high-risk to prevent infection.
2)To the extent increased utilization with PrEP among high-risk
populations reduces the number of HIV infections, there would
be offsetting cost savings for less HIV/AIDS treatment in
Medi-Cal and the AIDS Drug Assistance Program (ADAP).
3)Costs to the California Department of Public Health (CDPH) to
produce updated written material, and to modify HIV counselor
training, are minor and absorbable.
COMMENTS:
1)Purpose. According to the author, this bill seeks to reduce
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the spread of HIV and save the lives of individuals at high
risk of HIV exposure, by providing them with information about
preventive medications during HIV post-test counseling.
2)PrEP. According to CDPH, PrEP, is an important HIV prevention
option in which persons who are uninfected, but at significant
risk for acquiring HIV, take one pill a day to prevent
acquiring HIV. The medication currently approved by the
federal Food and Drug Administration for PrEP is co-formulated
emtricitabine/tenofovir (Truvada). The pill can reduce the
risk of HIV infection by up to 92% when consistently taken
once a day as prescribed. PrEP does not replace other risk
reduction options such as reducing the number of risk
exposures, consistent use of condoms, and suppressing viral
load through use of HIV medication among those who are HIV
infected.
3)PEP. These medications are used to prevent HIV from
replicating and spreading through the body after an exposure
to the virus. PEP is a short-term (28-day) intervention and
must be started within three days of an exposure - sooner, if
possible - to be effective. PEP was originally developed for
occupational exposures, such as needle-sticks in hospitals,
but is also effective for sexual exposures.
4)Related Budget Action. In the 2015-2016 Budget Act, the
California Legislature appropriated $2 million annually
(General Fund, $1.764 million in local assistance, $236,000
for state support) to DPH to establish a PrEP Navigator
Services Program to "?ensure access for and serve the most
vulnerable Californians at high risk for HIV." The primary
client target for the PrEP Navigator Services Programs are
gay, bisexual, transgender, or other MSM, transgender women
who have sex with men, and partners of HIV-positive people
with a detectable viral load and/or inconsistent
antiretroviral use. On March 3, 2016 OA announced nine
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applicants that were selected to receive funding for the PrEP
Navigator Services.
5)Support. AIDS Project Los Angeles and the Los Angeles LGBT
Center are the cosponsors of this bill and they state that
awareness and use of PrEP and PEP among Californians at risk
for HIV remain extremely low. They conclude it remains vital
to ensure that all individuals at risk for HIV receive
accurate information about PrEP and PEP, particularly
highly-impacted communities of color. A number of other
advocacy groups for HIV-infected individuals as well as
advocates for low-income and minority communities support this
bill.
6)Opposition. The AIDS Healthcare Foundation (AHF) writes in
opposition that HIV screening should be convenient and not be
burdened with additional activities that may not be necessary.
AHF asserts that the more time and demands are placed on the
person it is encouraging to be tested, the more likely the
person is to decline. AHF also notes that guidelines for
prevention and risk reduction are fluid, based on the most
recent advice from the CDC and CDPH, and that information to
be shared must be dictated by the needs and circumstances of
the person being tested. AHF also cites concern about
inappropriate use of PrEP among low-risk individuals.
Finally, AHF asserts the current language governing testing
has been carefully negotiated in prior years to minimize
burdensome requirements and avoid providing specific direction
to medical providers and HIV testers.
The California Hospital Association (CHA) also opposes this
bill, citing interference with the physician-patient
relationship and opposition to codifying standards of
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practice. The California Medical Association stated similar
concerns about a prior version of this bill; CMA's position is
unknown.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081