A conversation with Amber R. Tynan, CEO of Big Bend Cares, about the uncertain future of Florida’s AIDS Drug Assistance Program

This month, the Florida Department of Health dramatically reduced the eligibility for their AIDS Drug Assistance Program (ADAP), specifically from 400% of the federal poverty level to 130% of the federal poverty level, which is the approximate equivalent of dropping from $63,840 to $20,748 annually. The state also removed the antiretroviral medication, Biktarvy, from their list of covered drugs. The change took place on March 1, 2026.

However, last week, Senator President Jason Broder filed an amendment to provide gap funding for those affected by Florida’s ADAP through June 30, 2026.

Amber R. Tynan is the CEO of Big Bend Cares, which is a community-based, medical case management organization that serves individuals with HIV and AIDS in eight counties in Florida. They are considered a Part B provider for the Ryan White Federal HIV Program.

Tynan recently sat down with Managed Healthcare Executive to discuss the latest developments on the cuts, what they mean for public health safety and how patients are coping in the meantime.

This conversation has been edited for length and clarity.

MHE: Senator President Jason Broder filed an amendment to provide gap funding for those affected by Florida’s ADAP eligibility cut. How does this change the situation at hand right now?

Tynan: We're grateful for the stopgap measure, but it doesn’t include all the things that were eliminated as part of the emergency rulemaking.

We had been working closely with both Senate and House representatives throughout the entire session to share what this meant for us and what this meant for our clients, alongside a number of other advocates.

What it did for this three-and-a-half-month period is it allowed for us to increase eligibility for ADAP Direct Dispensing from what was changed to 130% FPL.

What it did not do is add Biktarvy back to the formulary. It also did not add back the Premium Plus Program, which is where ADAPs were allowed to pay for premium insurance plans for individuals living with HIV and AIDS and also cover the cost of their drugs and the cost of their medical appointments.

In totality, it was a great bipartisan effort to get to a place where we're going to try to stop the bleeding as best we can, but our hope is that when they reconvene in the middle of April, they will think long-term about adding those two provisions into next year's fiscal budget.

MHE: Florida removed Biktarvy from its ADAP. How big of an impact will this have?

Tynan: When we look at Florida in totality, of the 16,000 people that were impacted, 80% plus were on Biktarvy, and that matters, because when you're on a medication regimen that allows for viral suppression, you cannot transmit the disease.

When we shift to a two-dose regimen or something completely different, we don't know if individuals have a resistance factor that may impact their ability to change their regimen. We don't know some of the side effects that may impact based on other comorbidities they may have. Biktarvy was one of the most well-received and well-used drugs specific to our HIV/AIDS population because it is a single-dose regimen.

We are one subset of the state here in Florida, and of those impacted, we had about 234 clients. There was only one that we couldn't move away from Biktarvy.

Moving them to a different medication regimen means we have to update their care plans, and when you do that for 233 people, that creates an immense administrative burden.

MHE: What is the current morale among providers and their patients?

Tynan: There's a lot of uncertainty. When they made the announcement on January 8, they also shared that they were going to start sending letters to people that were impacted. What happened is that either individuals didn't receive their letters because they weren't sent or letters outing them from their status went to households that weren't theirs. There was no discretion used in the letter distribution, so anybody could have opened it.

At least 10% of the letters went to an address that wasn't current.

Providers were to be updated as well, but that didn’t happen either.

MHE: Are similar things going on in other states where coverage has been affected?

Tynan: Nothing as drastic as in Florida. We participate in a nationwide group specific to Ryan White clinic providers, and we know of 18 other states that are looking at changing their eligibility. Any disruption in eligibility is going to further exacerbate the continuum of care that we have in place.

It forces organizations like ours to find additional funding streams to offset no longer offering premium assistance. Do we then offer our own insurance premium assistance program to our clients so that they have end-to-end coverage? That's something they deserve. It's something they've had.

If the state is going to make such a drastic change, you should have your stakeholders engaged in the process. We didn't get that chance.

We were not engaged at all, and quite frankly, the state stopped participating in a number of our statewide calls months ago, which I think is telling. Yes, they had transition and leadership shifts, but I think they knew what was coming, and a lot of this hysteria could have been less heightened had we been engaged from the beginning to troubleshoot it.

MHE: Are these cuts something that you anticipated?

Tynan: A majority of individuals impacted by HIV and AIDS are usually men who have sex with men. They are generally a part of the LGBTQ community and largely people of color.

While we may not have fully anticipated that this was coming, the trends were pretty clear. We have this “anti-woke” as well as DEI initiatives being slashed. Policy and funding are going to shift with that ideology as well.

MHE: What is the main thing the public should know about this ongoing funding issue?

Tynan: The biggest thing that the general community needs to know is that this does not just impact people with HIV and AIDS. Yes, they are the benefactors of this ADAP program; however, it doesn't mean that if somebody loses their medication regimen and they're no longer supported by ADAP, that they're going to stop having sex and then that person stops having sex with somebody else.

It doesn't just impact those who currently have the disease; it's going to impact generations, because the behaviors of us as humans don't change just because this policy does. It's absolutely everyone’s concern. Without these protective measures that allow people to stay virally suppressed, we are going to see another epidemic like we did in the 80s and the 90s.

MHE: How are patients adapting to funding cuts?

Tynan: Some patients have quit their jobs so that they could fall below that 130% threshold so that they could stay medicated, but now they have other livelihood decisions they have to make. How are they then going to pay for their rent, their utilities and their food?

There are some patients who are increasing hours at their employer so that they can qualify for employer-compensated benefits, but that's a survival mechanism, not necessarily a strategic tactic.

I think we'll see a lot of people purchasing medications on the black market or sharing their medications. I think we'll see people skip a couple of doses so that they can prolong the amount of time in which they have their medication accessible to them.

We're going to see more creativity as time goes on, especially if, when the legislature reconvenes mid-April, they don't come up with a long-term solution.