States limiting HIV drug access as federal funding plateaus

More than 20 states are actively reducing or considering cutting back on their funding of programs helping people access HIV medications, as federal funding fails to keep up with the costs, according to a new report.

The report from the National Alliance of State and Territorial AIDS Directors (NASTAD) found that 23 states, including Washington D.C., are implementing or considering cost-containing measures of their AIDS Drug Assistance Programs (ADAP). This report was based on data from 44 states and territories.

The report said the federal funding has remained unchanged for more than decade, while demand and costs are increasing.

“Federal funding for ADAPs has remained relatively unchanged over the last decade, while client enrollment and healthcare costs, including prescription drug, insurance premium, and cost-sharing expenditures, have continued to increase,” the report stated.

ADAPs are federally funded assistance programs that provide assistance in the form of medication and other HIV-related services to low-income, uninsured and underinsured individuals with HIV.

Measures that states are implementing include lowering financial eligibility and bringing back waitlists or reducing their drug formularies, which dictate which drugs they cover. The report found 17 states and Washington, D.C. are actively seeking to constrain ADAP costs while the rest are still considering their options.

As KFF noted, more than a decade of stagnant appropriations from Congress — set at $900.3 million since fiscal year 2014 — have effectively resulted in ADAPs having the same purchasing power as they did in 1999 due to inflation.

The Trump administration’s budget request for fiscal year 2026 maintained ADAP funding but requested cuts to funding for other programs like dental care, education and training.

“ADAPs may increasingly face budget pressures that could lead to additional such measures in the future. This could leave growing numbers of people with HIV ineligible for safety-net services, particularly if states further lower income eligibility limits or institute waiting lists,” KFF’s analysis read.

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