Governor Gavin Newsom signed Senate Bill 1023, requiring health plans to cover long-acting injectable HIV pre-exposure prophylaxis through outpatient prescription benefits. The measure removes administrative barriers for community clinics and takes effect on January 1, 2027, as international access debates continue over the drug lenacapavir.
Governor Gavin Newsom signed Senate Bill 1023, authored by Senator John Laird, to require health plans that already cover injectable pre-exposure prophylaxis to offer reimbursement through outpatient prescription drug benefits as reported by the California State Senate. California lawmakers and health advocates moved to reshape access to HIV prevention by removing a major reimbursement hurdle for community providers.
Previously, health plans frequently restricted reimbursement to the medical benefit billing pathway. That administrative route forced healthcare providers to purchase medications up front and hire specialized staff to handle complex claims.
Senate Bill 1023 Solves Clinic Reimbursement Hurdles
Long-acting injectable PrEP offers patients an alternative to daily pills by requiring administration as infrequently as once every six months. Yet community health centers and smaller providers struggled to adopt the prevention tool under existing insurance rules.
PrEP is proven to prevent HIV, but it only works if people can get it. This new law removes an unnecessary barrier that has made it harder for community clinics and smaller providers to offer injectable PrEP.
Senator John Laird, via California State Senate
Insurance Commissioner Ricardo Lara stated that the law removes financial obstacles and gives providers greater flexibility in an official statement. Dr. Tyler TerMeer, CEO of the San Francisco AIDS Foundation, credited the measure with ensuring that insurance companies never stand in the way of prevention through published commentary. Co-sponsored by Insurance Commissioner Ricardo Lara alongside the California Department of Insurance, the San Francisco AIDS Foundation, Equality California, APLA Health, and the Los Angeles LGBT Center, the legislation passed as an LGBTQ Caucus priority measure according to state records.
Global Funding and Lenacapavir Access Shape the Pandemic Fight
Developed by United States pharmaceutical company Gilead Sciences, the twice-yearly injectable drug lenacapavir gained approval from the US Food and Drug Administration in June 2025 according to international reporting. While California expands state-level insurance pathways, the international context for long-acting HIV prevention medication faces funding pressures and pricing disputes.
Clinical trials involving more than 2,000 young women in South Africa and Uganda in 2024 showed that no participants who received lenacapavir contracted HIV as documented by Al Jazeera. Carlota Baptista da Silva, global HIV lead at Doctors Without Borders, described the compound as an innovation.
It’s the most innovative tool that has reached the HIV arena for the last decade, because it’s the closest we have [to] a vaccine.
Carlota Baptista da Silva, Global HIV Lead at Doctors Without Borders, via Al Jazeera
International HIV funding fell 18 percent in 2025 to $7.3bn, its lowest level in nearly two decades, according to data from the United Nations programme on HIV/AIDS cited in news reports. That financial squeeze reduced the number of individuals receiving risk-reduction medicine from 1.4 million in 2024 to 1.1 million in 2025 based on UNAIDS figures.
Generic Manufacturing and Country Exclusions Spark Disputes
In the United States, lenacapavir costs about $28,000 per person annually according to pharmaceutical pricing data. Gilead licensed six manufacturers to produce generic versions expected to cost about $40 a year, though large-scale generic rollout in low- and middle-income nations is not expected until 2027 reported by Al Jazeera.
Excluded territories accounted for close to 23 percent of new HIV infections globally in 2023 per agency calculations. Advocacy organizations have raised concerns over geographic restrictions tied to those licenses. Doctors Without Borders states that at least 26 middle-income countries are excluded from the main generics agreement, including nations with rising infection rates and regions that assisted in clinical trials according to published findings.
People should not really help generate the evidence for breakthrough medicine and then find that their country is excluded from affordable generic access.
Carlota Baptista da Silva, Global HIV Lead at Doctors Without Borders, via Al Jazeera
Gilead established a separate agreement with the Pan American Health Organization to create an access pathway for 14 Latin American and Caribbean countries outside the primary generic licensing territory, including Brazil, Mexico, Argentina, and Peru noted in network coverage. Meanwhile, Gilead supplies its own drug at no profit for programs supported by the Global Fund and the US President’s Emergency Plan for AIDS Relief in countries such as South Africa, Kenya, Zambia, Nigeria, and Eswatini according to corporate statements.
Gilead declined interview requests due to scheduling constraints, pointing via an emailed statement to an access strategy combining no-profit supplies, royalty-free licensing, and regional agreements reported by news outlets. Doctors Without Borders maintains that direct purchase requests for medical programs remain unfulfilled according to organizational briefings.