Task force sounds alarm on AIDS drug program funding cuts

Tim Horn

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The ADAP Crisis Task Force is comprised of ADAP administrators from nine states: Arizona, California, Illinois, New York, North Carolina, Pennsylvania, Texas, Virginia and Washington. For more information, visit nastad.org/resources/adap-crisis-task-force-fact-sheet

Information on Arizona’s program can be found at hivaz.org/arizona-aids-drug-assistance-program-adap and azadap.com

AIDS Drug Assistance Programs stand at a critical precipice. After a period of hard-won fiscal stability, numerous ADAPs are now operating in times of profound fiscal, administrative and programmatic uncertainty.

The ADAP Crisis Task Force is preparing for crucial negotiations with Gilead Sciences and Merck — two of the largest manufacturers of antiretroviral drugs — to ensure the survival and effectiveness of these vital programs nationally.

The ACTF and NASTAD — the National Alliance of State & Territorial AIDS Directors —applaud all major manufacturers of antiretroviral drug products for their stated commitment to the Ending the HIV Epidemic Initiative. However, this commitment must be met with strong, tangible commitments to state and territorial ADAPs.

It is crucial to recognize that essential HIV medicines from Gilead Sciences alone constitute approximately 60% of ADAP prescription drug expenditures. A key facet of ACTF negotiations with industry partners is ensuring the continuity of pricing that guarantees the affordability of antiretroviral drug products for all states and territories.

The data are undeniable: viral load suppression exceeds 85% among ADAP clients, a rate significantly greater than the estimated 65% of all people living with diagnosed HIV.

The challenges confronting ADAPs are unprecedented and necessitate enhanced cooperation efforts with our pharmaceutical partners:

• A looming federal funding crisis: The One Big, Beautiful Bill Act signed into law on July 4 threatens Medicaid with roughly $1 trillion in cuts over the next decade. This would drastically reduce access to care for millions, including thousands of people living with HIV/AIDS. The inevitable consequence will be a surge of low-income people desperately needing comprehensive HIV care from Ryan White HIV/AIDS Program providers, including state and territorial ADAPs. Compounding this, enhanced premium tax credits associated with Marketplace plans are set to expire later this year. The bill may also trigger approximately $500 billion in Medicare cuts and puts on hold implementation of finalized rules that would have made it easier for low-income Medicare beneficiaries to access Medicare Savings Programs and eliminates Medicare eligibility for people with lawful immigration status who have already paid into the program.
• Proposed cuts to HIV prevention and the cost of inaction: The potential for significant federal funding cuts to HIV prevention programs will undoubtedly lead to an increase in new HIV infections. This will directly translate to more individuals requiring access to costly antiretroviral treatment and, by extension, increased demand for ADAP services.
• Unfunded mandates and growing needs: Despite being flat-funded via Congressional appropriations for decades, ADAPs are forecasting significant growth in their programs due to these federal policy dynamics. This growth in demand comes at a time of great financial strain and uncertainty for RWHAP and ADAP programs.

• State health departments are already undergoing drastic budget cuts and reductions in force because of federal agency cuts, directing resources away from HIV care and treatment, and the threat of further cuts from federal agencies is always looming.

• As described above, sharp increases in the number of uninsured people with low incomes due to a confluence of federal policy changes will further strain RWHAP and ADAP budgets.
• ADAPs are already experiencing a steady increase in individuals aging with HIV who require critical wrap-around support to cover Medicare expenditures and access essential medications that may not be covered by Medicare Part D or Medicare Advantage plans. 

• Unsustainable drug costs: With list prices for essential HIV medicines exceeding $50,000 a year, securing the best possible discounted prices from manufacturers is not merely beneficial — it is essential for ADAPs to maximize their programs and serve the largest number of low-income PLWHA without implementing cost-containment strategies. Alarmingly, several ADAPs are already beginning to plan for dire cost-containment measures, including waitlists.
• Eroding financial stability: Other current challenges include decreased rebates due to changes to Medicare cost-sharing requirements associated with the Inflation Reduction Act, increased competition for 340B program savings and partial Notices of Awards to RWHAP Part B programs due to the Continuing Resolutions.

The best possible pricing for ADAPs is, in effect, a direct investment in the success of these programs and, by extension, a critical investment in national efforts to end HIV as an epidemic in the United States.

The ACTF urges its community partners to stand with its members as it presses for terms that reflect the gravity of this moment and the undeniable impact of ADAPs in saving lives and advancing public health.

Editor’s note: Tim Horn is director of medication access at NASTAD. Please send your comments to AzOpinions@iniusa.org. We are committed to publishing a wide variety of reader opinions, as long as they meet our Civility Guidelines.