New state law requirement to provide HIV postexposure prophylaxis treatment in emergency departments

New Law: Hospital Action Required

To:	Chief Executive Officers, Chief Medical Officers, Chief Nursing Officers, Pharmacy Leads, Legal Counsel, and Government Affairs Leaders Please forward to relevant staff, including billing
Staff Contact:	Katerina LaMarche, JD, Policy Director katerinal@wsha.org | (206) 216-2505
Subject:	New state law requirement to provide HIV postexposure prophylaxis treatment in emergency departments

 

Purpose
The purpose of this bulletin is to provide hospitals information about a new law, ESSB 6127, which requires hospitals to dispense or deliver HIV postexposure prophylaxis (PEP) drugs or therapies to patients upon discharge from the emergency department who may have been exposed to HIV.  This 28 day supply of drugs is intended for take home use by the patient.

As originally proposed in the legislature, the bill did not require reimbursement as a separate covered service and contained operational concerns and statutory conflicts. WSHA successfully advocated to require coverage for the provision of HIV PEP drugs and therapies and ensure the requirements were operationally feasible. WSHA was also able to exclude antibiotics from the 48-hour supply limitation.

Community pharmacies should be the place where patients are dispensed medication for take-home use. However, the legislature felt strongly that given the challenges with patients accessing these drugs, emergency departments should provide them.

Applicability/Scope
Effective January 1, 2025, ESSB 6127 applies to all acute care hospitals.

Recommendations

1. Review this bulletin and ESSB 6127 to understand the new requirements.
2. By January 1, 2025, develop a policy and have procedures in place, consistent with Centers for Disease Control (CDC) guidelines, to dispense or deliver HIV PEP drugs or therapies upon discharge to patients seen in the emergency department following possible exposure to HIV.
3. Ensure that the hospital is able to stock HIV PEP medications as prepackaged prescriptions for patients seen in the emergency department.
4. When available, hospitals must provide generic HIV PEP drugs or therapies.
5. Review contract agreements and contact insurers for any special instructions or requirements for billing.
6. Review contract agreements to determine whether health plans will reimburse dispensing a full course of antibiotics to patients discharged from the emergency department. Review policies on dispensing antibiotics to patients discharged from the emergency department and update if desired.

Overview
Beginning January 1, 2025, hospitals must adopt a policy and have procedures in place to dispense or deliver HIV PEP drugs or therapies to patients who may have been exposed to HIV. The drugs or therapies must be provided upon discharge to patients who were seen in the emergency department (ED).

Hospitals may dispense a full course of antibiotics to patients discharged from the emergency department.

Specifications and Requirements:

1. The hospital’s policy and procedures must be consistent with current CDC guidelines.
2. Patients must provide informed consent to HIV PEP.
3. Hospitals must provide consenting patients a 28-day supply of HIV PEP drugs or therapies unless medically contraindicated, inconsistent with accepted standards of care, or inconsistent with CDC guidelines.
4. When available, hospitals must dispense or deliver generic HIV PEP drugs or therapies.

Prepackaged Medication Exemption Allows Distribution of HIV PEP Medications and Antibiotics for Patients Discharging from Emergency Departments:
ESSB 6127 amends RCW 70.41.480 to allow a distribution of prepackaged emergency medications when a patient is identified as needing HIV PEP drugs or therapies.

Generally, hospitals are limited to dispensing no more than a 48-hour supply of emergency medications to a patient except when community or hospital pharmacy services will not be available within 48 hours. To ensure that hospitals are able to dispense a 28-day supply as pre-pack emergency medication, the bill exempts HIV PEP drugs or therapies from the 48-hour limitation.  Dispense and deliver are defined in accordance with RCW 18.64.011.

The bill also exempts antibiotics from the 48-hour limitation. This is unrelated to the provision of HIV PEP medications. WSHA negotiated the inclusion of this exemption following conversations with members. This will allow a hospital to dispense a full course of antibiotics to patients discharged from the emergency department. The bill, however, does not require reimbursement for a full course of antibiotics.

Coverage and Reimbursement:
The bill prohibits patient cost-sharing and preauthorization. State-regulated commercial plans, health plans offered to public employees, and Medicaid plans (fee-for-service and managed care organization), are required to reimburse a hospital that bills for a for a 28-day supply of any PEP drugs or therapies dispensed or delivered to a patient in the emergency department for take-home use. This reimbursable expense is separate from any bundled payment for emergency department services.

The bill does not impact the process for coverage for reimbursement of PEP drugs through the crime victims’ compensation program or the industrial insurance act through the Department of Labor and Industries for drugs dispensed or delivered to a worker exposed to HIV through the course of employment.

Background
Hospitals are not currently required to provide HIV PEP to patients nor does the law allow a hospital to provide a 28-day course as recommended by the CDC. The intent of ESSB 6127 is to increase access to HIV PEP drugs and therapies for patients seen in a hospital emergency department.

WSHA’s 2024 New Law Implementation Guide
Please visit WSHA’s New Law Implementation Guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2024 to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.

References
ESSB 6127
CDC HIV PEP Guidelines
Worker and Crime Victim Compensation Information