State says AIDS drug program could need more money

A key state program that helps provide HIV medications remains financially vulnerable despite lawmakers stepping in earlier this year to prevent major cuts, according to a report released Monday by the Florida Department of Health.

The report argues the state will not be able to secure enough funding for the AIDS Drug Assistance Program if it continues serving people with incomes up to 400 percent of the federal poverty level.

ADAP, which is funded through a combination of state money, federal grants and pharmaceutical rebates, has faced cuts and declining participation after the state said reduced federal funding required lowering the program’s eligibility threshold.

According to the report, annual pharmaceutical rebates have ranged from $158 million to $200 million. For the 2026-2027 fiscal year, however, the state expects to receive an estimated $62.8 million.

The state says this is because lawmakers expanded the income threshold to 400 percent of the federal poverty level, which may “shift participants from insured (rebate-generating) models to direct dispense (non-rebate) models.”

The full impact will not be known until September, according to the report.

The report comes after lawmakers acted earlier this year to restore cuts to the program.

In January, the Department of Health, citing a $120 million shortfall caused by federal funding reductions, announced it would lower the coverage threshold from 400 percent of the federal poverty level — an annual income of $62,600 — to 130 percent of the federal poverty level, or $20,345 annually.

The change resulted in approximately 11,000 HIV-positive Floridians losing access to medications and care through the program.

The agency also removed some of the most widely used medications from its approved drug list and stopped paying premiums for Affordable Care Act plans in March.

In response, the Legislature approved a stopgap measure that included $31 million to restore cuts to ADAP through June 30, the end of the fiscal year. The measure also included reporting requirements, directing the Department of Health to submit monthly accounting reports on the program to lawmakers.

The bill did not restore coverage for Biktarvy, the most commonly prescribed once-daily HIV medication, and some other drugs were switched to generic alternatives.

For the fiscal year beginning July 1, the state set aside $75 million for ADAP, more than the $68 million originally proposed by the House but still more than $40 million short of what the Senate sought to provide.

According to the report, ADAP enrollment has increased by about 9,000 participants over the past five years. As of last month, 27,757 people were enrolled in the program.