Almost 5,000 people in California are newly diagnosed each year with HIV, the human immunodeficiency virus that causes AIDS. The greatest burden of these new infections occurs in men who have sex with men and Black and Latinx people.
Since 2012, four HIV pre-exposure prophylaxis (PrEP) medications have been introduced that, taken by people who do not have HIV, reduce the risk of getting HIV from sex by 99% and from a drug injection by at least 74%, according to the National Institutes of Health. To make the PrEP drugs more widely accessible, the state of California enacted two laws that enabled pharmacists to prescribe an initial 60-day supply of PrEP (SB 159, 2019) and to provide ongoing PrEP care (SB 339, 2024).
But, surprisingly less than 3% of California community pharmacies are actually offering HIV PrEP services, according to a study led by UC Berkeley School of Public Health for the California HIV/AIDS Policy Research Centers (CHPRC).
The research, published April 20 on the CHPRC website, was led by Stefano M. Bertozzi, professor of Health Policy and Management, and Lauren Hunter, a UC Berkeley postdoctoral scholar. The investigators found that out of 910 pharmacies surveyed, only 31 offered pharmacist-initiated PrEP services and of those, only five offered the long-acting injectable (LAI) medication [Apretude or Yeztugo], which the public health community believes many patients would prefer over taking pills every day.
The authors noted that pharmacist-initiated PrEP implementation was low across all California geographic subregions and was limited to a subset of Albertsons-owned chain pharmacies, small chain or franchise pharmacies, and independent pharmacies.
“PrEP uptake remains limited by inequities in healthcare access and other barriers such as low awareness, stigma, and medical mistrust,” they wrote.
The survey was conducted between July and November 2025, using a mystery client approach. Student investigators called pharmacies to say, “Hi, I was wondering if I can get PrEP drugs for HIV prevention from your pharmacy without a prescription from a doctor?”
The authors noted that pharmacists are already key providers of other injectables, including a substantial share of all COVID-19 vaccines in the United States. In addition, they reference their earlier 2023 report, also conducted for CHPRC, which found that half the pharmacists questioned said they were willing to provide LAI PrEP under enabling conditions, highlighting the potential for pharmacist-initiated LAI PrEP to address gaps in HIV prevention.
In an interview Dr. Hunter noted that California has been a national leader in enabling pharmacist practice expansion, which made it clear that there were roadblocks to initiating HIV PrEP that need to be solved.
One problem might be that while California law requires many health plans to reimburse pharmacists for providing the PrEP service—not just for the medication itself—in practice, most pharmacists are not actually able to be reimbursed for the PrEP service.
“We’ve heard anecdotally from many pharmacists that those reimbursement challenges are a major barrier,” Hunter said. “As our next step, we’re exploring what policy or regulatory changes might be needed to overcome those barriers.”
Read the full study here.
This news release was published by University of California Berkeley Public Health on April 22, 2026.
