State drug-assistance cuts
Florida's AIDS Drug Assistance Program cut financial eligibility from 400% to 130% of the Federal Poverty Level effective March 1 2026, discontinued the premium assistance program, and reduced its formulary. Cost-sharing assistance remains available to self-insured clients with incomes up to 400% FPL.
Approximately 12,000 Floridians are projected to lose AIDS Drug Assistance Program (ADAP) coverage under the new ceiling, per the state. Premium assistance discontinued; cost-sharing assistance for self-insured clients remains up to 400% Federal Poverty Level (FPL).
Source: NASTAD ADAP Watch, February 2026 · accessed 2026-05-23State drug-assistance cuts
Pennsylvania's AIDS Drug Assistance Program cut financial eligibility from 500% to 350% of the Federal Poverty Level for new applicants beginning October 1 2025, with current clients reassessed at next reenrollment cycle.
Roughly 1,592 Pennsylvanians are estimated newly ineligible at the lower ceiling. Current clients reassessed at next reenrollment.
Source: NASTAD ADAP Watch, February 2026 · accessed 2026-05-23State drug-assistance cuts
Sector-wide: 10 state and territorial ADAPs forecast major deficits for fiscal year beginning April 1 2026.
NASTAD ADAP Watch February 2026 reports 44 state and territorial AIDS Drug Assistance Programs responded to its Request for Information (data collected January 20-30 2026). For the fiscal year ending March 31 2026: 5 programs reported minor deficit (<5% of budget), 5 reported major deficit (>5%). Forecasting the next fiscal year starting April 1 2026: 10 programs forecast minor deficit, 9 forecast major deficit. Zero waiting lists currently reported.
Source: NASTAD ADAP Watch, February 2026 · accessed 2026-05-23Federal Ryan White cliff
The House Appropriations Committee's FY2026 Labor-HHS-Education bill cuts $525.4 million from the Ryan White HIV/AIDS Program, lowering total appropriation to $2 billion. The bill eliminates Part C (Early Intervention), Part D (Children/Youth/Women/Families), Part F (AIDS Education Training Centers and Dental Programs), and the Ending the HIV Epidemic initiative.
Senate markup pending. The bill would zero out Parts C, D, F and the Ending the HIV Epidemic (EHE) initiative.
Source: HIV Medicine Association news release · accessed 2026-05-23Federal Ryan White cliff
The White House FY2026 request lowers the Ryan White HIV/AIDS Program (RWHAP) by $74 million and eliminates Part F.
The White House FY2026 budget request funds the Ryan White HIV/AIDS Program at $2.5 billion (a $74 million decrease, 3% reduction from FY2025), eliminates Part F (AIDS Education Training Centers, Dental Programs, Special Programs of National Significance demonstrations), includes $165 million for Ending the HIV Epidemic activities within Ryan White, and proposes moving the program from the Health Resources and Services Administration to a new Administration for Healthy America entity.
Source: KFF analysis · accessed 2026-05-23Pharma landscape
The U.S. Food and Drug Administration approved lenacapavir (brand name Yeztugo) on June 18 2025 as the first and only twice-yearly subcutaneous injectable pre-exposure prophylaxis for adults and adolescents weighing at least 35 kg at risk for HIV-1 acquisition. List price: $14,109 per shot ($28,218 per person per year). Manufacturer: Gilead Sciences. Mechanism: HIV-1 capsid inhibitor.
Insurance must cover preventive services at no cost, but step therapy is permitted. Populations most affected by step-therapy gating overlap with the populations Community Health Worker (CHW) and Ryan White Part B-funded programs serve.
Source: San Francisco AIDS Foundation · accessed 2026-05-23Litigation watch
The U.S. District Court for the District of Maine paused implementation of the HRSA 340B Rebate Model Pilot Program on December 29 2025. The U.S. Circuit Court of Appeals for the First Circuit affirmed the pause on January 7 2026 in American Hospital Association et al. v. Kennedy et al. The pilot covers 10 non-HIV drugs selected for Medicare Drug Price Negotiation Year 2026 (Eliquis, Enbrel, Farxiga, Imbruvica, Januvia, Fiasp/NovoLog, Jardiance, Stelara, Xarelto, Entresto).
Implementation of the rebate-model pilot remains paused pending appeal. Manufacturer approvals issued October 2025 are not in effect.
Source: The Pharma Force · accessed 2026-05-23Litigation watch
Iowa's Department of Health and Human Services filed a nine-page complaint in Polk County District Court on March 6 2026, alleging that NuCara Specialty Pharmacy failed to remit more than $22 million in 340B program income generated through Iowa's AIDS Drug Assistance Program. The complaint covers eight missed monthly payments from October 2024 through January 2026. Iowa terminated the contract the same day it sued.
A 340B contract pharmacy dispute large enough to disrupt a state ADAP cash position. Worth tracking as a template other states may follow.
Source: HIV/HCV Watch · accessed 2026-05-23Acronyms — ADAP: AIDS Drug Assistance Program. RWHAP: Ryan White HIV/AIDS Program. EHE: Ending the HIV Epidemic. FPL: Federal Poverty Level. CHW: Community Health Worker. 340B: Drug Pricing Program under section 340B of the Public Health Service Act.