BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2640 (Gipson) - Public health: HIV
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|Version: August 2, 2016 |Policy Vote: HEALTH 7 - 1 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 8, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 2640 would require a health care provider
administering an HIV test to provide information on preexposure
prophylaxis (PrEP) and postexposure prophylaxis (PEP) to a
patient determined to be at high risk for HIV infection.
Fiscal
Impact:
Likely ongoing costs in the millions to low tens of millions
to provide PrEP and PEP to high-risk individuals enrolled in
Medi-Cal (General Fund and federal funds). Based on Centers
for Disease Control and Prevention estimates for the number of
individuals at high risk for HIV infection, staff estimates
that there are about 150,000 individuals in the state that
would meet CDC guidelines for using PrEP or PEP. For each 1%
of that population that elects to begin taking PrEP, the
proportional cost to the Medi-Cal program to cover the cost of
providing PrEP would be about $4 million per year. (Costs for
PEP would be considerable lower, since it is only recommended
for 28-day use, as opposed to ongoing use for PrEP.)
AB 2640 (Gipson) Page 1 of
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Unknown long-term savings to Medi-Cal and the Aids Drug
Assistance Program due to lower HIV infection rates (General
Fund and federal funds). To the extent that the bill does
result in lower HIV infection rates, there would be cost
savings to the Medi-Cal and Aids Drug Assistance Programs.
However, there are some factors that limit the potential cost
savings from the bill. First, it is not known how effective
greater knowledge and use of PrEP and PEP are at the
population level in reducing HIV infection. There are clinical
studies that show a very dramatic decline in HIV infections
amongst users of PrEP. Whether those findings would translate
to the larger population not part of a research study is
unknown. Second, the annual cost to provide PrEP is may not be
substantially less than the current cost to provide treatment
to HIV positive Medi-Cal beneficiaries. The cost that Medi-Cal
would pay for PreP is not public information. However, the New
York State Department of Public Health indicates that annual
costs range from $8,000 to $14,000 per year. Even assuming
that Medi-Cal receives significant discounts, the cost to
provide PreP is likely to be in the thousands per patient per
year. On the other hand, the current average annual cost of
care for an HIV positive Medi-Cal beneficiary is about $15,000
per year.
Background: Under current law, patients who have blood drawn at primary
care clinics must be offered an HIV test by the clinic.
Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
In addition, the Department of Public Health manages the Aids
Drug Assistance Program which offers coverage for treatment of
HIV to those who do not qualify for Medi-Cal.
Current law mandates that all individual and group health plans
AB 2640 (Gipson) Page 2 of
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and insurance policies provide coverage for HIV testing.
Under current law, specific information must be provided by a
health care provider who is administering an HIV test, for both
individuals testing positive and individuals testing negative
who are at high risk for HIV infection.
Proposed Law:
AB 2640 would require a health care provider administering an
HIV test to provide information on preexposure prophylaxis
(PrEP) and postexposure prophylaxis (PEP) to a patient who tests
negative but is determined to be at high risk for HIV infection.
Related
Legislation: AB 2439 (Gipson) would create a pilot project to
assess the effectiveness of routinely offering HIV tests in the
emergency department of a hospital. That bill will be heard in
this committee.
Staff
Comments: There is a great deal of uncertainty in how
individuals at high risk of HIV infection will respond to
receiving information about PrEP and PEP. Assuming even a small
number of such individuals who test negative for HIV would seek
PrEP, costs to the Medi-Cal program could be substantial. Of
course, any action that reduces HIV infection would have
substantial population health benefits and would lead to cost
savings to Medi-Cal.
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