James Conrad writes for BrokeAssStuart.com and plays guitar in Remedy Feelin'. He lives in San Francisco.
On 2 September 2025, StatNews.com reported that biopharmaceutical company Gilead Sciences, currently the largest maker of HIV medicines, plans to boost prices significantly for several treatments that are widely distributed by state AIDS Drug Assistance Programs (ADAP) to about 110,000 low-income HIV and AIDS patients unable to afford comprehensive and sufficient health care coverage.
This decision will inevitably compound financial worries faced by these programs as a result of federal funding cuts made by the Trump regime, particularly plans to lay off 10,000 employees at the U.S. Department of Health and Human Services. In turn, the federal funding cuts made to programs like Medicaid may force states to cut their health care budgets. Even more alarming, reductions in federal funding for HIV prevention programs could precipitate a rise in new cases of HIV and AIDS, which would further strain the resources of AIDS Drug Assistance Programs.
Mike Weir, legislative and policy affairs director at the National Alliance of State and Territorial AIDS Directors, stated in an email sent to HIV community programs nationwide, ADAPs “stand at a critical precipice,” citing “unsustainable” costs for prescription medicines. In this email, he also stressed that it was “essential” that ADAPs be granted the best possible discounts from manufacturers in order to serve the most patients without resorting to cost-cutting, as list prices for crucial HIV medicines invariably exceed $50,000 per year.
“Alarmingly, several ADAPs are already beginning to plan for dire cost-containment measures, including wait-lists,” advised Weir in the email.
Carl Schmid, the executive director of the HIV+Hepatitis Policy Institute, a nonprofit dedicated to improved health care access for low-income patients, states, “More people are coming off marketplace plans and Medicaid, so there is more pressure being placed on ADAPs. We’re worried about the future because of the cuts and ADAPs are the payer of last resort.”
According to Tim Horn, head of the medication access program at NASTAD, approximately 90% of ADAP spending on prescription drugs is for HIV medications. In 2023, that amounted to $972 million before rebates. Weir also noted that 60 percent of the HIV drugs purchased by ADAPs, such as Biktarvy, Genvoya, Descovy, and Odefsey, are manufactured by Gilead.
Established in 1987, the ADAPs are funded by the Ryan White HIV/AIDS Program, a federal initiative that provides essential medical care and support services for under-insured and uninsured AIDS patients. Unfortunately, the federal monies allocated to ADAPs has plateaued at just over $900 million since fiscal year 2014 while the purchasing power of US currency has continued to diminish with inflation since that time.
Considering that, Tim Horn predicts that there will be a “...cascade of consequences. This could mean that ADAP budgets need to increase, which requires retaining more rebates [to provide services] and potentially requiring the states to take more Ryan White funds to give to the ADAPs in order to make the ADAPs whole,” he explained. “In other words, financial stress gets passed around.”
Horn also notes that for the time being, Gilead has requested recent utilization data from ADAPs to better understand how their budgets will be impacted in the event of price hikes on HIV drugs and that Gilead last raised prices in the mid-single digits in 2023 after freezing prices for several years.
“We had a very productive meeting [with Gilead], but none of us have a crystal ball about specific implications [government] health care reforms will have ADAPs face dire uncertainties over the next couple of years. Even a 10% price increase would be seriously detrimental. … And their proposal is out of lock step with the rate of inflation.”
The next meeting between NASTAD and Gilead is scheduled to take place in October.
Jacquelyn Clymore, the HIV/STI/hepatitis director in the Communicable Disease Branch of the North Carolina Department of Health and Human Services, which oversees the state ADAP, states, “We want the manufacturers to understand how much we appreciate what they do. But any increase would be a concern. ADAPs have finite resources. There has not been an increase in funding for a long time.”
Perhaps Gilead’s willingness to negotiate with NASTAD has come as a result of negative publicity the company has experienced on account of its greedy business practices. For example, in July 2023, the New York Times reported that internal documents at Gilead Sciences, Inc. revealed that the company decided to delay the release of an updated
Tenofovir formula that was potentially less toxic to patients’ kidneys and bones than the previous formula to prolong its patent protections specifically in order to maintain a monopoly on the market, prevent competitors from producing less expensive alternatives, and keep the prices for its Tenofovir-based drugs at a premium.
More recently, in April 2025, the United States Department of Justice reached a $202 million settlement with Gilead after the company was found to have violated the Anti-Kickback Statute and the False Claims Act by giving health care practitioners money and all-expenses-paid travel to attend and speak at events that were often little more than social gatherings, with little or no educational content on display.
Raising prices on medications may seem to be a small thing. Many Americans have come to regard rising inflation as normal and predictable and indeed unavoidable, especially where drug prices are concerned. However, this particular change is a significant one and should not escape attention. The price hike in question is above the rate of inflation, and if it does take effect, it would cripple a program patients rely on in order to survive. Affected patients, their families, and friends should pay close attention.
