Florida HIV Medication Cuts Could Lead to 4,300+ New Infections

Florida has significantly restricted access to a vital program that helps people with HIV afford their medication, a move that experts warn could lead to increased infections and jeopardize the health of thousands. The changes, implemented through an emergency rule on Sunday, drastically narrow eligibility for the state’s AIDS Drug Assistance Program (ADAP), impacting an estimated 16,000 residents.

Eligibility Changes and Potential Impact

Previously, Floridians were eligible for ADAP assistance if their income was at or below 400% of the federal poverty level – roughly $64,000 annually for a single-person household in 2026, according to the Department of Health and Human Services. The 2025 poverty guidelines are used to determine eligibility. The new rule lowers that threshold to 130% of the poverty level, less than $21,000 per year for an individual. This change effectively cuts off assistance for many who rely on the program to access life-saving HIV treatment.

Modern HIV medications, when taken as prescribed, can reduce viral load to undetectable levels, allowing people with HIV to live essentially normal lifespans. Undetectable equals untransmittable (U=U) is a widely accepted principle in HIV care. Still, consistent access to these medications is crucial to maintaining viral suppression. The Florida ADAP changes threaten that access for a significant portion of the state’s HIV-positive population.

Formulary Changes and Medication Access

The new rule also removes Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide, Gilead Sciences) from the ADAP formulary. Biktarvy is a commonly prescribed, once-daily pill that accounts for 52% of new or changed prescriptions for HIV medication in Florida, according to Gilead Sciences. This means patients currently on Biktarvy may be forced to switch medications, potentially leading to complications or treatment failure. The March 2026 Florida ADAP formulary details the covered medications.

Expert Concerns and Projected Infections

“This news is devastating to say the least,” said Aadia Rana, MD, an infectious diseases professor at the University of Alabama at Birmingham and senior scientist in the school’s Center for AIDS Research. “In a state that has the third highest rates of both new cases as well as those living with HIV in this country, any potential interruptions in HIV therapy… has the potential to increase the rate of uncontrolled virus and worsen outcomes for people living with HIV in Florida.”

Preliminary analysis by Melissa Schnure, PhD, a senior epidemiologist at the Johns Hopkins University School of Medicine, suggests the cuts could lead to 4,312 more HIV infections in Florida between 2026 and 2030 – a 28% increase compared to projections if ADAP remained unchanged. This analysis builds on previous research demonstrating the critical role of programs like ADAP in controlling the HIV epidemic. A simulation study showed that eliminating the federal Ryan White HIV/AIDS Program, which funds state ADAPs, would lead to a 73% surge in new HIV infections nationwide.

Broader Trends in HIV Funding

Florida is not alone in facing cuts to HIV funding. Data from the National Association of State and Territorial AIDS Directors (NASTAD) indicate that 23 states, along with Washington, D.C., have implemented or are considering reductions to ADAP. The February 2026 ADAP Watch report provides a detailed overview of these changes. However, the cuts in Florida are particularly severe, raising significant concerns about the state’s commitment to HIV prevention and treatment.

Advocacy and Response

HIV advocates estimate that up to 16,000 of the 30,000 individuals enrolled in the Florida ADAP could lose eligibility as a result of the new rule. Anna K. Person, MD, chair of the HIV Medicine Association, issued a statement condemning the cuts, warning that they will “threaten the lives of people with HIV and will lead to spikes in new HIV diagnoses and a rise in health care costs.”

The Florida Department of Health has stated that reducing ADAP eligibility “will prevent a shortfall of more than $120 million for Florida.” However, critics argue that the long-term costs of increased HIV infections and complications will far outweigh any short-term savings. The department did not immediately respond to requests for further comment.

The situation remains fluid, and advocacy groups are exploring legal and legislative options to challenge the new rule and restore funding to the Florida ADAP. Individuals affected by these changes are encouraged to contact their state representatives and advocate for continued access to HIV care.

For more information:

Aadia Rana, MD, can be reached at [email protected].

Melissa Schnure, PhD, can be reached at [email protected].