Description
Background: Pre-exposure prophylaxis (PrEP) remains substantially underutilized in the United States, with only 25% of eligible individuals receiving it. Community pharmacists represent an accessible setting for care delivery, with nearly 90% of Americans living within five miles of a pharmacy; however, state laws governing pharmacist involvement in PrEP vary substantially. This study characterizes state-level variation in pharmacist scope-of-practice policies for HIV prevention across the United States. Methods: We conducted a cross-sectional policy surveillance study using the NASTAD Pharmacist Authority Database, state statutes, regulations, and legislative session laws. State laws and regulations were coded across five domains: (1) oral PrEP/PEP prescribing authority, (2) injectable PrEP administration authority, (3) collaborative practice agreement (CPA) provisions, (4) reimbursement structure, and (5) insurance access protections. Descriptive statistics were used to summarize policy prevalence and key sources of variation across domains. Supplementary analyses will examine longitudinal trends to assess how pharmacist scope of practice for HIV prevention has evolved over time. Preliminary Results: Nineteen states (37.3%) authorize pharmacist-initiated oral PrEP or PEP, with mechanisms ranging from independent prescribing to standing orders. Explicit PrEP-specific legislation addressing injectable PrEP was identified in only one state (2.0%), highlighting a major gap as long-acting formulations expand. CPA authority exists in 46 states (90.2%), but differs in patient specificity, training requirements, and administrative provisions. Among states authorizing pharmacist-initiated oral PrEP or PEP, 11 (57.9%) require pharmacist training. Only four states (7.8%) mandate reimbursement parity with physicians. Among the 26 states with any reimbursement law, 22 (84.6%) restrict pharmacist reimbursement to Medicaid. Conclusion: Findings show substantial cross-state variation in how states organize pharmacist-delivered HIV prevention, suggesting potential barriers to consistent pharmacist-delivered PrEP access. Greater policy alignment across prescribing authority, administration authority, reimbursement, and insurance protections may be needed to support broader implementation of pharmacist-delivered HIV prevention services. These findings identify specific policy gaps that may limit the scale-up of pharmacist-led HIV prevention services nationwide.
Publication Info
2026.