Many of the cuts that disrupted HIV care for thousands of Floridians have been restored; advocates say important gaps remain
Florida lawmakers have reached a budget agreement reversing many of the planned cuts to the state’s AIDS Drug Assistance Program (ADAP), which covers HIV medications and services to low-income Floridians. Gov. Ron DeSantis is expected to sign the agreement, which will take effect July 1.
The budget agreement:
provides $75 million for ADAP
maintains income eligibility at 400% of the federal poverty level
restores the formulary, including Biktarvy
removes prior authorization for Descovy
However, advocates did not get everything they wanted. Although drug co-pay and deductible assistance are available, premium assistance is not. And the agreement caps the number of participants in direct-dispense enrollment at 21,000 Floridians. Direct dispensing is for uninsured people who receive their medications directly through either a health department pharmacy or contracted pharmacy.
Still, it was a major victory for advocates, who have fought for months to restore ADAP benefits, which were slashed in January and resulted in an estimated 16,000 residents losing access to HIV care and treatment. In March, state lawmakers approved a stopgap bill allocating more than $30 million in emergency funding to ADAP, but the measure provided funds only until the end of June, and it didn’t address the removal of Biktarvy from the formulary.
Removing restrictions on the formulary is important, so people will no longer be burdened with what’s become a month-long backlog for prior authorization.
Though advocates wanted clear reinstatement of premium assistance, lawmakers did remove the prohibition on the use of premium assistance, said Michael Rajner, a former consumer representative to the Florida Department of Health’s ADAP Advisory Workgroup and one of the leaders pushing to restore ADAP benefits.
“We believe that another administration could try reinstating premium assistance or doing a pilot project,” Rajner told POSITIVELY AWARE. “But there’s not a clear pathway right now.”
The only premium assistance in Florida is through a patchwork of community-based organizations that have 340B pharmacy programs. Rajner said there’s no data yet on how many organizations and how many clients are receiving assistance this way, but it’s being compiled. Community-based groups, already facing staffing and budget constraints, are further stretched by offering premium assistance, he said.
“There’s one organization that I spoke with in South Florida where they currently assist approximately 300 clients with their premium assistance, and they break even,” he said. “But one of the burdens on them is the workload on staff, and it’s taking them away from being able to assist clients with other needs.”
The budgetary solution was possible because Florida lawmakers are in session nearly year-round, unlike in some other states, such as Missouri, where are also facing cuts to ADAPs and other Ryan White services.
While Rajner celebrates the victory and praises lawmakers and other advocates who pushed for a solution for months, he’s still disappointed with the Florida Department of Health, which he said has “gone rogue and shut the community out.” He added that the work of community partners and Floridians with HIV is not yet done.
“It’s an election year and there will be a new governor in January in Florida, and there will be a new administration in all the different agencies, and so the community will have to reestablish a relationship with the Department of Health under new leadership,” he said. “We really have to see if they’re willing to begin to partner with the community and engage stakeholders and be transparent.”