Public Citizen Demands Florida Reverse HIV Medication Cuts
Public Citizen Comments to Florida Department of Health on Rules Updating Eligibility for AIDS Drug Assistance Program (ADAP)
Citizen is a nonprofit consumer advocacy organization with more than one million members and supporters throughout the U.S., including many members in Florida. Public Citizen’s Access to Medicines Program works with partners across the U.S. and around the world to make medicines available for all through tools in policy and law and has a long history of fighting for equitable access to affordable HIV/AIDS medications.
We strongly oppose Florida’s proposed rule changes that would lower income eligibility for the state’s AIDS Drug Assistance Program (ADAP) to 130% of the federal poverty level from 400% and eliminate health insurance premium assistance. More than 16,000 HIV-positive Floridians are expected to lose ADAP coverage as a result of these changes equivalent to more than half of the total Floridians served by ADAP in 2023. The changes are penny wise but pound foolish. They will ultimately harm the state’s public health and economy much more than any temporary budget relief experienced by the state.
A loss of ADAP coverage will jeopardize Floridians medication adherence, which is crucial for keeping the HIV virus in check, preserving the health of the patient and the broader Florida community. The Centers for Disease Control and Prevention has found that persons with an unmet need for medications from ADAP were approximately five times as likely to be nonadherent because of cost (32%) than those who received ADAP (7%).
Medication nonadherence can lead to increased viral load and raises the risk of HIV transmission to others. It also increases the likelihood of the virus mutating and a person developing drug-resistant HIV. Ultimately, lack of medication can lead to greater medical costs and death. The annual economic impact of medication non-adherence per person for patients with HIV and AIDS is estimated to range from nearly $17,000 to more than $30,000. Using the low end of that estimate, Florida could wind up spending $272 million per year due to these ADAP changes, more than double the $120 million shortfall Florida is attempting to avoid by changing its ADAP’s eligibility criteria and benefits.
Public Citizen is also concerned by Florida’s decision to remove the antiviral Biktarvy from its ADAP formulary effective March 2026, seemingly with no public deliberation or explanation, even as the same drug remains on the state Medicaid program’s preferred drug list. Biktarvy is the most widely prescribed HIV medication in the U.S. Removing it from ADAP is expected to harm Floridians’ health and further increase costs for the state. Medication switching can lead to drug resistance in HIV. Biktarvy is also the only single tablet regimen in U.S. HIV treatment guidelines. Single treatment regiments may help improve patient adherence to treatment by reducing their pill burden.
The Southern portion of the U.S. accounts for about half of new HIV infections in the country despite representing less than 40 percent of the U.S. population and Florida has the third highest HIV death rate in the country. Florida’s proposed ADAP changes will only make the state further stand out for all the wrong reasons. Floridia must swiftly reverse course to protect the health of its citizens and economy. Public Citizen asks that you immediately restore and stabilize ADAP. Thank you for your consideration.
Sarah Karlin-Smith
Research Director, Public Citizen Access to Medicines Group