Nation’s largest AIDS Drug Assistance Program hit in Florida, other states follow suit

A Florida Department of Health ruling has officially decreased funding for the state’s AIDS Drug Assistance Programs (ADAP) and reduced Biktarvy eligibility and is expected to impact approximately 16,000 HIV patients in the state, according to ABC. Florida's ADAP program serves more than 32,000 clients, making it the nation’s largest. A Florida Department of Health news release states that the cuts were necessary to avoid a projected $120 million budget shortfall.

Florida’s decision, which went into effect on March 1, is not a standalone choice — 23 other states, including Washington, D.C., have either already implemented similar cuts or are considering doing so, according to new data from the National Association of State and Territorial AIDS Directors.

“We’re seeing patients across the state full of anxiety and fear rationing their lifesaving medication,” Esteban Wood, director of advocacy and legislative affairs at the AIDS Healthcare Foundation, told The New York Times.

For advocates, reducing Biktarvy access is especially troubling.

Biktarvy is a life-saving antiretroviral medication. It is the most widely prescribed HIV treatment in the United States. The once-daily pill contains bictegravir, emtricitabine and tenofovir alafenamide, which, when combined, reduce the viral load in the body, making it undetectable. If HIV levels are undetectable, that means it cannot be transmitted. However, the medication must be taken every day to be effective, which means the cuts could result in an uptick of HIV cases. Approximately half (40%) of new HIV infections are transmitted by people who are aware of their HIV status but have unsuppressed viral loads.

ADAPs are funded through the Ryan White Federal HIV Program. These programs help HIV patients pay for their medications, fully covering the cost of some drugs and the insurance premiums for others.

Specifically, Florida reduced ADAP eligibility 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.

There are a variety of factors that impact ADAP funding, including the rising cost of HIV drugs, increased insurance premium costs, increased client enrollment and a lack of federal funding, which has remained relatively unchanged over the last decade, according to the NASTAD report.

“Effectively, programs are being asked to do more with less federal funding,” Lindsey Dawson, associate director of HIV policy at KFF, told The New York Times.

CMS has opened a special enrollment period for affected Floridians. During the enrollment period, which ends on April 30, people who qualify will be able to choose a new coverage plan to help cover the cost of their medications.

However, experts warn that many patients may still be overlooked.

“These are people who have no other safety net,” Wood added. “ADAP is the safety net.”