Trending Now - States Impose Restrictions on HIV Treatment Access Due to Budgets

WHO:

Lindsey Dawson, associate director of HIV policy at KFF

Tim Horn, director of medication access at the National Alliance of State and Territorial AIDS Directors

Esteban Wood, director of advocacy and legislative affairs at the AIDS Healthcare Foundation

Florida health department

WHAT:

Nearly 20 states are imposing restrictions on Ryan White AIDS Drug Assistance Programs (ADAPs).

Florida cut off benefits for at least 16,000 residents living with HIV on February 28, 2026.

Florida will no longer cover Biktarvy, the most widely prescribed HIV medication.

ADAPs support approximately 25% of the 1.2 million people living with HIV in the United States.

Enrollment in ADAPs surged by 30% from 2022 to 2024.

Florida's income eligibility for ADAP reduced from 400% of the federal poverty level (FPL) to 130% FPL, equating to an annual income of $20,748 from $63,840.

The Florida health department cited a projected $120 million budget shortfall as the reason for the adjustments.

18 states have implemented or are considering cost-cutting measures for ADAPs.

23 states, including Washington, D.C., are implementing or considering ADAP cost-containment measures.

The average wholesale price (AWP) for Biktarvy was $61,000 in 2025.

The average premium cost for benchmark plans increased by 26% from 2025 to 2026.

WHERE:

Florida

Pennsylvania

Kansas

Delaware

Rhode Island

18 states across the United States

WHEN:

Changes in Florida's ADAP took effect on February 28, 2026.

The special enrollment period by the Centers for Medicare & Medicaid Services for Floridians ends on April 30, 2026.

Pennsylvania amended its eligibility criteria in the fall of 2025.

The last significant waiting lists for ADAPs were cleared in 2013.

WHY:

Budget constraints and rising costs of HIV medications are leading to restrictions in ADAPs.

The expiration of enhanced Affordable Care Act premium tax credits is increasing out-of-pocket premiums for clients.

The Florida health department's adjustments are due to a projected $120 million budget shortfall.

HOW:

States are tightening eligibility requirements and reducing the number of medications covered in ADAPs.

Florida's health department filed an emergency rule to enforce the restrictions beginning on February 28, 2026.

Advocacy groups have filed an injunction against Florida's health department to halt the ADAP restrictions.

In a significant move, Florida has cut off benefits for at least 16,000 residents living with HIV, effective February 28, 2026, as part of a broader trend where nearly 20 states are imposing restrictions on Ryan White AIDS Drug Assistance Programs, or ADAPs. The Florida health department cited a projected $120 million budget shortfall for these changes, which include reducing income eligibility from 400% to 130% of the federal poverty level and discontinuing coverage for Biktarvy, the most widely prescribed HIV medication. Advocacy groups are responding by filing an injunction against these restrictions, as enrollment in ADAPs surged by 30% from 2022 to 2024, highlighting the critical support these programs provide to approximately 25% of the 1.2 million people living with HIV in the U.S.