HIV Drug Assistance

People living with HIV (PLWH) in Florida above certain income limits remain eligible to use the state’s drug assistance program to cover their medications—at least for a few more months. State lawmakers approved emergency funding on March 12 to restore income eligibility parameters after Florida officials proposed lowering them for the state’s AIDS Drug Assistance Program (ADAP), which helps cover drug copays for PLWH. Republican Governor Ron DeSantis signed the measure into law on March 24. Florida’s ADAP also stopped making premium payments for insured program participants and covering Biktarvy, an HIV treatment drug, for uninsured enrollees; the emergency appropriations addressed neither of these latter two changes, allowing both to continue.

Although leaders in many states are considering difficult cost-containment measures to sustain HIV drug programs, Florida’s recent proposal—intended to address a $120 million budget shortfall—represents the most dramatic change proposed so far. Lowering the income eligibility threshold from 400% to 130% of the Federal Poverty Level decreases the qualifying annual income from $63,840 to $20,748, a reduction that would eliminate nearly half of the program’s current enrollees.

Because the bill, HB697, only restores income eligibility, individuals losing access to premium payment assistance will still be affected and can change their plans via a Special Enrollment Period (SEP) that takes place through April 30 on healthcare.gov. Advocates have argued that the other intact program modification restricting access to Biktarvy, one of the most widely prescribed HIV treatment regimens in the U.S., will exacerbate health outcomes by disrupting adherence and viral load management.

STI Testing at the Pharmacy

Pharmacists in Rhode Island may soon be allowed to conduct more STI testing in response to potential exposure. State Representative Michelle McGaw (D – Portsmouth) introduced legislation that would expand pharmacists’ authority to “test-and-treat” for certain authorized conditions, including STI post-exposure prophylaxis (PEP). Current state law allows pharmacists to prescribe HIV PrEP and PEP medications with a collaborative practice agreement or non-patient-specific standing orders. This bill would extend that authority for pharmacists to independently use certain tests for STI exposure, increasing access to rapid results for many infections, such as syphilis, chlamydia, gonorrhea, trichomoniasis, and/or Mycoplasma genitalium.

Syringe Exchange Programs

After several amendments and lengthy debate, a majority of Indiana’s state policymakers passed bipartisan legislation to extend the state’s syringe exchange program for five more years. Governor Mike Braun (R) declined to sign the bill, enabling it to become law automatically after eight days. The governor stated he believes the bill did not address the underlining causes of intravenous drug use in the state, which has fueled a public health emergency across the entire nation for decades. The program will still allow individuals in six Indiana counties to exchange used syringes for sterile ones, but it now limits where exchanges can take place and requires identification to verify state residency. Hoosier lawmakers first legalized exchanges after a historic HIV outbreak in Scott County took place in 2015, resulting in over 200 new HIV diagnoses among people who inject drugs, the vast majority of whom had also acquired hepatitis C. Advocates in the state have argued that extending the program will not only prevent more HIV and hepatitis C transmission, but also ultimately save the state money on medical costs.