Opioid Use Disorder Among Medicare Beneficiaries

By: Ranier Simons, ADAP Blog Guest Contributor

The United States has the highest levels of opioid consumption worldwide (Cornell et al., 2021). This consumption level is not solely attributed to recreational use but is also a product of prescription rates. United States healthcare providers prescribe opioids for pain more often and at earlier points in treatment, sometimes as first-line therapy (Cornell et al., 2021). This is especially concerning regarding people living with HIV/AIDS (PLWHA). Compounding the potential adverse effects of medically prescribed opioids, PLWHA also have a much higher prevalence of non-medical opioid use compared to the general population of HIV-negative individuals (West et al., 2023). A recent study examined opioid use among older PLWHA specifically.

Photo Source: Clinical Trials Arena

A recently published retrospective cross-sectional study analyzed opioid utilization and the prevalence of opioid use disorder (OUD) among Medicare beneficiaries. The study subjects were aged 65 and older and beneficiaries of Medicare fee-for-service with Part D prescription drug coverage. The study covered the period from January 1, 2008, to December 31, 2021 (Shiau et al., 2025). The researchers examined 163,429 PLWHA, comparing them to 490,287 individuals without HIV, matching based on demographic criteria. 

During the study timeline, 35% of PLWHA, compared to 28.3% of HIV-negative subjects, were prescribed at least one opioid annually (Shiau et al., 2025). PLWHA had a higher prevalence of being prescribed higher-risk prescriptions. High-risk opioid prescriptions are those with higher dosages and longer durations. Dosages are commonly measured in morphine milligram equivalents (MME). Dosages higher than 100 MMEs have twice the risk of misuse and overdose as lower doses, while dosages of 20-50 MME also carry risk (U.S. Dept of Labor, n.d.). In the study cohort, 5.3% of PLWHA received prescriptions with total daily MMEs higher than 90mg compared to 2.2% of those without HIV (Shiau et al., 2025). Additionally, 3.1% of PLWHA, compared to 1.6% of those without HIV, were prescribed opioids with MMEs higher than 120mg (Shiau et al., 2025). Regarding prescription duration, 6.1% of PLWHA, compared to 3.9% of individuals without HIV, were prescribed high-risk opioids with coverage of longer than 90 consecutive days of use (Shiau et al., 2025). 

Photo Source: AIDS Map

It is notable that among the study participants, there was a higher prevalence of OUD indicators in PLWHA compared to those who were HIV-negative. The data analyzed were administrative; thus, OUD indicators include formal diagnosis, OUD medication, and opioid-related emergency department visits (Shiau et al., 2025).  

PLWHA are prescribed opioids for chronic pain. That pain can have multiple causes, such as HIV-related nerve damage, pain from opportunistic infections acquired due to lowered immune response, antiretroviral treatment side effects, and more (Lutton, 2025; Madden et al., 2020). Opioid abuse is not only medically detrimental overall but also has HIV-specific adverse outcomes. PLWHA with OUD are more likely to have difficulty with ART adherence. This is especially true for PLWHA who are also living with mental health challenges. Gravely, ART, opioids, and drugs used to treat OUD are metabolized in the body via the same biochemical pathways (Cernasev et al., 2020). Thus, there can be adverse drug interactions. Moreover, ART medications can enhance or decrease the levels of opioids or OUD treatment drugs in the bloodstream (Cernasev et al., 2020). There are times when the interactions can increase the effectiveness of the ART, opioids, or OUD treatment medications (Cernasev et al., 2020). However, many times the result is often reduced effectiveness or even toxicity (Cernasev et al., 2020). All these potential adverse outcomes are compounded by the fact that many PLWHA have comorbidities.

Photo Source: Valley Spring Recovery Center

Studies indicate that over half of PLWHA will have nonmalignant chronic pain at points throughout their lives (Madden et al., 2020). As a result of medical advances in HIV treatment, PLWHA are living longer. Thus, the population of PLWHA over the age of 65 is going to continue to increase, as will chronic pain issues. The Shiau study indicates the importance of examining better ways to treat chronic pain in PLWHA that do not rely on high-risk opioids. A direct quote from the study text includes, “…clinicians treating older adults with HIV should consider alternative therapies for pain, and public health researchers and policy makers should consider screening and prevention programs for opioid use disorder in older adults living with HIV” (Shiau et al., 2025). 

It is essential to emphasize the holistic well-being of older PLWHA. Physical health, mental health, sexual health, and addiction are all realities that need to remain priorities for all medical professionals who give care to aging populations.

[1] Cernasev, A., Veve, M. P., Cory, T. J., Summers, N. A., Miller, M., Kodidela, S., & Kumar, S. (2020). Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders. Pharmacy (Basel, Switzerland), 8(3), 168. https://doi.org/10.3390/pharmacy8030168

[2] Cornell, A., Davis-Castro, C., Duff, H., Romero, P. (2021, June 2). Consumption of Prescription Opioids for Pain: A Comparison of Opioid Use in the United States and Other Countries. Retrieved from https://www.congress.gov/crs-product/R46805

[3] Lutton, L. (2025, October 7). Opioid Prescriptions, Addiction More Common in Older HIV Patients. Managedhealthcareexecutive.com; Managed Healthcare Executive. Retrieved from https://www.managedhealthcareexecutive.com/view/opioid-prescriptions-addiction-more-common-in-older-hiv-patients

[4] Madden, V. J., Parker, R., & Goodin, B. R. (2020). Chronic pain in people with HIV: a common comorbidity and threat to quality of life. Pain management, 10(4), 253–260. https://doi.org/10.2217/pmt-2020-0004. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC7421257/#:~:text=Abstract,(e.g.%2C%20stigma)%20factors.

[5] Shiau, S., Drago, F., Kinkade, C. W., Getz, K., Bushnell, G., Samples, H., Bender, A. A., Bennett, L., Dave, C., Halkitis, P. N., Gerhard, T., Roy, J. A., Martins, S. S., Yin, M. T., & Crystal, S. (2025). Prescription opioid use and opioid use disorder among older adults with HIV in the USA from 2008 to 2021: a retrospective repeated cross-sectional study. 100017–100017. https://doi.org/10.1016/j.lanprc.2025.100017. Retrieved from https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(25)00017-2/fulltext

[6] West, B. S., Diaz, J. E., Philbin, M. M., & Mauro, P. M. (2023, April). Past-year medical and non-medical opioid use by HIV status in a nationally representative US sample: Implications for HIV and substance use service integration. Journal of Substance Use and Addiction Treatment, 147, 208976. https://doi.org/10.1016/j.josat.2023.208976. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S2949875923000267#:~:text=Conclusion,%2Drelated%20outcomes%2C%20including%20overdose.

[7] U.S. Department of Labor. (nd). Risk Factors for Opioid Misuse, Addiction, and Overdose. Retrieved from https://www.dol.gov/agencies/owcp/opioids/riskfactors

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.    

Why are Price Cap Proposals on Medicines Dangerous to Pharmacies and Patients?

By: Shabbir Imber Safdar, ADAP Advocacy Board Member and Executive Director, Partnership for Safe Medicines

**Reposted with Permission from PSM**

Price cap proposals, like upper payment limits currently being debated by prescription drug affordability boards (PDABs) and Medicare maximum fair prices (MFPs), often assume a simple drug/price supply chain which doesn’t reflect reality in the United States. They also don’t account for the fact that members of the drug/price supply chain will react to price caps in ways that could bankrupt pharmacies and reduce patient access.

Colorado approved an upper payment limit on Enbrel a few days after we posted this. We anticipate that this decision will be bad for pharmacies and patients.

The U.S. healthcare system is uniquely complex

Pharmaceuticals in the United States have an incredibly complex supply chain. Everyone agrees that more should be done to address the cost of medicine, but developing workable cost-reduction policies is challenging. This is because unlike a hardware store, where the maker, distributor, and retailer of a hammer are linear and all actors fear competition, the U.S. healthcare market is far more complex.

Healthcare system players like pharmacy benefit managers (PBMs) gatekeep patients from their local pharmacies. It’s as if the maker or distributor of a hammer could tell your local hardware store whether customers could use your hardware store and what you were allowed to charge for the hammer, regardless of how much it costs for you to buy it.

A teachable moment

Recently Dr. Emily Zadvorny of the Colorado Pharmacists Society provided public comment to the Colorado Prescription Drug Affordability Board about their efforts to set upper payment limits for several medicines. Several other states are in this process, and the federal government has been engaged in setting MFPs for medicines in Medicare.

Dr. Zadvorny’s testimony underscored problems with price-setting policy solutions to healthcare costs in the U.S.

"...up to 90% of independent pharmacies are already saying they will not participate in the medication in the Medicare Drug Price Negotiation Program, precisely because there is no guarantee that they can not be underwater on those drugs." [Dr. Emily Zadvorny, 7/11/2025]

Dr. Zadvorny was talking about multiple risks to pharmacies and to patients, which we’ll explain below.

PBM reactions to price caps that affect pharmacy

Most price cap proposals only concern themselves with the maximum price manufacturers, distributors, pharmacies, and insurance companies can charge or reimburse for a medicine. Reducing the maximum price means that players, such as PBMs, will make less money when drugs are dispensed to patients.

Policies like UPLs and MFPs don’t always prevent monopolistic players like PBMs from lowering reimbursements to maintain their profits under the price cap. For example, imagine a medicine that costs a pharmacy $1,000 to purchase. The PBM makes $150 on that medicine and reimburses the pharmacy $1,010. If a price cap says that you can only charge $500 for the medicine, the PBM is likely to lower the reimbursement for the pharmacy to $350. The PBM maintains their $150 profit, and the pharmacy loses money.

Even if the UPL rules say that a medicine can only be sold for $500 and must be reimbursed at the same price of $500, the pharmacy will make $0. Your local hardware store cannot stay in business buying and selling items for $0 profit, and neither can your local pharmacy. How will it pay for salaries, rent, insurance, utilities, and other costs of doing business?

This 2-page summary explains the problem of PBM under reimbursements

Pharmacies as financial lenders to the healthcare system

The Medicare MFP system sets a maximum reimbursement Medicare will pay for a medicine, but leaves the cost of medicines untouched. It requires drug manufacturers to rebate pharmacies for the difference between the two. If the manufacturer is not required to compensate the pharmacy for their full cost, it will be catastrophic. Pharmacies can not stay in business without being made whole on their costs or without making profits.

However, there is another problem: The time between when pharmacies purchase medicine and when they are fully reimbursed is an enormous interest-free loan that pharmacies, which are already operating on razor thin margins, cannot afford. Estimates are that this could be thirty days, or even more. In January 2025, 3Axis Advisors found that under Medicare’s drug price negotiation program pharmacies could see a weekly cash flow shortfall of $10,838.25 compared to prior operations. Nearly 2,300 pharmacies shut their doors during 2024, primarily for financial viability reasons, and cash flow problems because of these proposals will accelerate closures.

Read Unpacking the Financial Impacts of Medicare Drug Price Negotiation on the 3Axis site

What effect will this have on patients?

Many pharmacies have already decided not to stock price-controlled medications rather than risk financial ruin. In fact, the National Community Pharmacists Association (NCPA) January 2025 survey of independent pharmacies found that over 90 percent of independent pharmacies may decide, or have already decided, not to stock price controlled drugs from the Medicare Drug Price Negotiation Program.

Patients cannot get quality healthcare from a pharmacy that’s out of business or that can’t afford to stock the medicine that patients need. Additionally, PBMs may make less profitable price-controlled medicines harder to obtain by placing them on a harder to reach tier, or by hiking patient co-pays, which also impedes access.

Community pharmacies are wary of stocking price controlled drugs from the Medicare Drug Price Negotiation Program (NCPA member survey, January 2025)

Don’t pharmacies make their money on “dispensing fees” anyway, instead of the cost of medicine itself?

Dr. Zadvorny brought this up in her public comment:

We did get [a dispensing fee] into the rules. We got it into the law. But what I heard earlier today that concerns me is that it would be left up to private contracts to ensure that. I can tell you right now that a lot of private contracts are either pennies for a dispensing fee, or sometimes it's not even made whole.

It can be $0. I think if there's any possibility to pay for this, for the board to ensure that there's a fair dispensing fee, I would absolutely implore you to do that. The state of Colorado does gather, cost of dispensing surveys. And there is data on what the real cost of dispensing a medication is. I would encourage that the dispensing fee that's included in these UPL [upper payment limit] drugs is no less than what is in that data from the cost of dispensing survey. [Dr. Emily Zadvorny, 7/11/2025]

Dr. Zadvorny is referring to PBMs giving pharmacies a dispensing fee of a penny (yes, an actual penny) or a few cents for the cost of all the work that goes into dispensing a medicine. This, combined with reimbursements for the cost, or sometimes less than the cost of medicine, explains why pharmacies are wary of proposals that might incentivize PBMs to cut their reimbursements further.

The actual cost of dispensing has been studied in Colorado and at the national level. The state of Colorado does an annual survey of dispensing fees to ensure that fees paid to pharmacies for serving Colorado Medicaid members are aligned with the actual costs of dispensing. In 2025, that cost was estimated at $9.31 to $13.40 per prescription for non-rural pharmacies, based on volume.

A 2020 NCPA study determined a normal dispensing fee should be $12.40, with a higher fee of $73.58 for specialty medicines. Many of the medicines the Colorado PDAB are looking at for upper payment limits are considered specialty medicines.

Example from a 2023 PBM contract showing no payment of dispensing fees

Why can’t we have negotiated prices like Canada?

The Canadian healthcare system for medicine has shortcomings around patient access that we don’t talk about. However, one advantage they do have is a lack of pharmacy benefit managers. PBMs exist in Canada, but do not dictate the terms of every other player in the system as they do in the U.S. healthcare system.

What should we be doing instead?

Stakeholders from all across the supply chain are nearly unanimous in their calls for PBM reform. The business practices of PBMs hamper patient access and bankrupt pharmacies that provide critical patient care.

Managed Medicaid reform

States looking for savings ideas could learn a great deal from states that have reformed the role of PBMs in their Medicaid programs. West Virginia and North Dakota carved prescription drug benefits out of their managed program and saved $54 million and $17 million respectively in a single year. Kentucky moved to a single PBM in 2020 and documented $282.7 million in savings for the 2021-2022 cycle. For more information on savings in this area, see this NCPA publication “Medicaid Managed Care Reform.”

PBM reform to reduce costs in the private insurance market

The Washington State Pharmacists Association, the Washington Health Alliance, and 3Axis Advisors recently undertook the largest state-focused study of the drivers of prescription drug costs. They studied prescription drug costs in the state using data collected from plan sponsors and pharmacies. They found that:

• Markups at PBM-affiliated mail-order pharmacies were more than three times higher than those at retail pharmacies.
• Plan sponsor (employer) costs increased by 30 percent, while commercial pharmacy reimbursement decreased by 3% between 2020-2023.
• PBMs charged employers vastly different amounts for the same prescription medications.
• PBMs drove an increase in employer health care costs over the past four years.

The evidence is that PBMs are increasing costs and decreasing reimbursements, taking money from all other players in the supply chain in ways that benefit themselves. Reforming their role in healthcare by putting strict guardrails on their business practices would create enormous cost reductions and increase access for every other stakeholder.  The full study is available online.

Original Post: Why are price cap proposals on medicines dangerous to pharmacies and patients?

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.    

Fireside Chat Retreat in Atlanta, GA Tackles Inflation Reduction Act's Adverse Impact on Patient Care

By: Brandon M. Macsata, CEO, ADAP Advocacy & Matt Toresco, Chief Executive Officer, Archo Advocacy LLC

ADAP Advocacy hosted its Health Fireside Chat retreat in Atlanta, Georgia, among key stakeholder groups to discuss the adverse impact on patient care being caused by the Inflation Reduction Act (IRA). The Health Fireside Chat was held from Thursday, September 25th, to Saturday, September 27th. It was a continuation of the conversation surrounding the IRA's drug price controls, which convened earlier this year in Minneapolis, MN. Over two dozen diverse health policy stakeholders attended the event.

Photo Source: Getty Images

The IRA discussion —including its pill penalty provisions, challenges community pharmacies are facing, more restrictive drug formularies increasing, non-medical switching, and patients absorbing greater costs due to shifts from co-pays to co-insurance—was designed to capture key observations, suggestions, and thoughts about how best to address the challenges being discussed at the Health Fireside Chat. The following represents the attendees:

• Guy Anthony, Founder & Executive Director, Black, Gifted & Whole Foundation
• Ninya Bostic,  National Policy & Advocacy Director, Johnson & Johnson
• Richard Brown, Development Manager, Patient Advocate Foundation
• Tori Cooper, Director of Community Engagement, Human Rights Campaign
• Erin Darling, Associate Vice President & Counsel for Federal Policy, Merck
• Nick Garlow, Managing Director, Rational360
• Dusty Garner, Patient Advocate
• Kathie Hiers, President & CEO, AIDS Alabama
• Mark Hobraczk, Director of Public Policy, Ai Arthritis
• Connie Jorstad, Director of Government Relations, ViiV Healthcare
• Amanda Kornegay, Owner, Kornegay Consulting, LLC
• Jen Laws, President & CEO, Community Access National Network
• Darnell Lewis, Paramedic Crew Chief & Patient Advocate
• Brandon M. Mascata, CEO, ADAP Advocacy
• Travis Manint, Director of Communications, Community Access National Network
• Michiel Peters, Head of Advocacy Initiatives, Global Coalition on Aging
• Kalvin Pugh, Director of State Policy, 340B, Community Access National Network
• Stacy Reliford, Alliance Development Director, Pfizer
• Andrew Scott, Director Strategic Alliances and Issue Advocacy, Bristol-Myers Squibb
• Larry Scott-Walker, Patient Advocate
• Ranier Simons, Consultant, ADAP Advocacy
• David Spears, Founder & Director, Magic Box LLC
• Jason Sterne, Director, Policy Advocacy and Alliances, Gilead
• Matt Toresco, CEO, Archo Advocacy
• Monique Whitney, Executive Director, Pharmacists United for Truth and Transparency
• R. Wayne Woodson, Executive Diretor, NEASM

To level set and provide background for discussions, attendees are sent suggested readings in advance. The following are just a few from the thorough list provided for this session:

• The Inflation Reduction Act (IRA): Impact on Medication Pricing, Spending, Affordability, and Access – Analysis by Pioneer Institute
• Alarm Bells are Ringing: Medicare Drug Price Negotiation Program Will Fail Without Changes – Op-Ed by B. Douglas Hoey, RPh, MBA in Drug Topics
• CMS Draft Guidance Creates Regulatory Vacuum in 340B Drug Pricing – Blog by Travis Manint, Community Access National Network
• Is Trump's Executive Order on Most Favored Nations Drug Pricing a Wet Noodle? – Blog by Ranier Simons, ADAP Advocacy
• Three reasons Congress should fix the IRA’s pill penalty – Blog by Brianna Allen, PhRMA
• The Inflation Reduction Act’s Impact Upon Early-Stage Venture Capital Investments – Article in Therapeutic Innovation & Regulatory Science

ADAP Advocacy is pleased to share the following brief recap of the Health Fireside Chat. There were two discussion frameworks:

What Does Effective Advocacy Look Like:

• Defining Effective Advocacy: Data-Guided Strategies for Patient & Policy Impact
• What Works: Cutting Through the Noise in Patient Advocacy
• Shaping Advocacy That Moves Policy
• Building the Blueprint: Effective Advocacy Together

Measuring What Success Looks Like:

• Redefining Success: Measuring Advocacy Wins for Patients & Policy
• What Counts: Defining Real Success for Patients & Policy
• From Policy to Impact: What Success Really Means & Looks Like in Action
• Measuring The Wins: Success Through Shared Impact

Every major policy fight (IRA, 340B, PDABs) ultimately comes back to protecting the patient–provider relationship and the decisions made within it. Patient advocacy is most effective on these issues through branding and and demonstrating value. To that end, patient advocacy must grow its brand and demonstrate both its current and future impact. Meanwhile, pharmaceutical industry partners need to better communicate the value of advocacy internally across medical, policy, regulatory, commercial, and patient support teams. Building capacity, whether alone or in partnership, is essential.

The group identified numerous policy priorities and the need for better coalition building. Future patient advocacy has to address gaps in access to care and treatment. The IRA weakens Medicare's Six Protected Drug Classes and policymakers need to be reminded why these health conditions were protected in the first place. Advocacy organizations need to focus on clearly describing the impacts of policy issues and helping patients see them, as is being done with educating patients on why reforms are needed to strengthen the 340B Drug Pricing Program.

The ongoing government shutdown also shaped much of the policy discussion, with an agreement that longtime allies in Congress need to be engaged but also potential new voices should be cultivated. The work done by patient advocacy groups and healthcare provider associations working with North Carolina Republican Senator Thom Tillis was cited as a prime example. Sen. Tillis has introduced legislation—"Ensuring Pathways to Innovative Cures (EPIC) Act"—to fix the Inflation Reduction Act's small molecule “pill penalty” to ensure continued R&D investments into small molecule medicines.  The Global Coalition on Aging and the Alliance for Aging Research spearheaded 70+ organizations in sending a letter to congressional leadership urging them to support the EPIC Act.

Photo Source: Government Printing Office

Some recent and upcoming milestones offer patient advocacy organizations additional opportunities to shape the policy conversation. They include:

• September 30, 2025: CMS released final guidance for third cycle (IPAY28) of the MDPNP. CMS released IPAY28 draft guidance in May 2025 for public comment, with the final guidance outlining the process for the third cycle of negotiations.
• October 2025 [Anticipated]: Release of expert report detailing drugs anticipated to be selected in 2026 for the MDPNP. Based on 2024 activities, it is expected that a new white paper or brief will be issued in September 2025 that identifies drugs that are likely to be subject to price negotiation in the third cycle of the MDPNP.
• February 1, 2026: CMS releases the list of drugs selected for negotiation. In 2026, CMS will announce the selection of 15 Part D and Part B drugs for which negotiated prices will go into effect in 2028.
• February 1 – March 1, 2026: Public input period (Information Collection Request, or ICR) following CMS announcement of drugs selected for negotiation. The ICR period is intended to help CMS understand how selected drugs are used and their relative value in clinical practice. Individuals can answer questions across varying respondent types (manufacturers, patients/caregivers, physicians, researchers, and "others"), often with a ~3,000-word limit per question. Question topics include therapeutic alternatives, clinical effectiveness, cost/affordability, unmet needs, patient experiences, and other considerations. 

Aligned stakeholders must use every opportunity to create a public record on the issues related to the Inflation Reduction Act and its impact on chronic health conditions and rare diseases.  No additional Health Fireside Chats are planned for 2025.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

HIV Clusters Spread, as Republicans Seek Deep Cuts to HIV Funding

By: Ranier Simons, ADAP Blog Guest Contributor

In the current political climate, given the government’s health policy landscape, many stakeholders are concerned about the stability of public health. This is undeniably true in the HIV space. Republicans seek deep cuts to HIV prevention and treatment funding, which would destabilize the already tenuous nature of care for people living with HIV/AIDS (PLWHA), especially those in vulnerable populations. Hindering effective HIV response is disconcerting, with trends such as HIV clusters appearing. In recent times, HIV cluster outbreaks have been identified. Fruitful public health support of PLWHA requires an increase in resources, not a reduction.

Photo Source: Maine.gov

One such cluster of increased HIV transmission is in Penobscot County, Maine, where Bangor is located. A cluster outbreak was first identified there in late 2023 (Budlon, 2025). A cluster is a group of people with related HIV infections. As of September 2025, the number of cases in this cluster has reached 29 (main DHHS). This area of Maine typically sees only two instances of transmission per year (Budlon, 2025). The majority of those involved in this cluster have been experiencing homelessness, injection drug use, or both in the 12 months before their diagnosis (Tusinksi, 2025). These conditions do not cause HIV; however, they do increase the risk of transmission. Housing instability hinders treatment adherence and consistent access to HIV care. Injection drug use can lead to behavior with increased risk, including sharing needles (Arum et al., 2021). Public health officials infer that the number of transmissions is likely higher than 29, given that many have not been tested.

Another cluster seeing a notable increase is in New York. The increase in infections in a reported cluster in Broome County, New York, in early August is higher than the number seen annually over the past four years. Most of those in the cluster are unhoused, have used intravenous drugs, are Caucasian, and between the ages of 30 and 45 (McCarthy, 2025). In addition to those identified in the clusters, the Broome County Health Department estimates there are a couple of dozen more people who have been exposed to HIV that they are not aware of (McCarthy, 2025). Additionally, as of 2023, Broome County has the third-highest rate of new Hepatitis C mortality in New York state (McCarthy, 2025). Hepatitis C, tuberculosis, Hepatitis B, and syphilis are often comorbid with HIV (McCarthy, 2025). HIV transmission has historically been overrepresented in the South; thus, this Northeastern trend is concerning.

Actions by the current administration are in direct opposition to supporting the reversal of these transmission trends. Reductions in HIV-related funding are harmful on many levels. In a July 2025 Executive Order (EO), the President implies defunding harm reduction. Harm reduction includes syringe service programs (SSP) in which evidence-based data shows that they are one of the best ways to prevent HIV and Hepatitis spread among those who inject drugs. Unlike the EO states, SSPs or safe consumption sites do not facilitate or worsen drug use. Two prominent SSPs in Maine have already shut down. The Maine Center for Disease Control and Prevention revoked the Health Equity Alliance’s (HEAL) syringe exchange certification in January 2025 (Bush, 2025). Additionally, due to a zoning issue, SSP Needlepoint Sanctuary was forced to close in July 2025 (Rupertus, 2025).

The language of the EO also paints the unhoused as a criminal group riddled with drug addiction and mental health disease, deserving of involuntary commitment to facilities to restore public safety. The President’s prescription of rounding up people experiencing homelessness and destroying encampments is the same sentiment that resulted in Camp Hope being closed in February of this year. It was the largest homeless encampment in Bangor, Maine (Peters, 2025). Many of those pushed out of the encampment have not been connected to residential situations and remain unhoused. The encampment served as a means for public health providers to reach unhoused PLWHA for treatment and tracing. However, with the residents of the encampments now scattered, any linkage to care that had occurred is destroyed. That is detrimental to PLWHA and the public since HIV prevention is a public issue.

Photo Source: CNN

The House Republican budget proposal slashes federal HIV prevention and treatment funding, seeking almost $2 billion in HIV-related cuts (Ryan, 2025). This is coupled with the large number of HIV related NIH grants that have already been defunded. In a speech, NIH Director Dr. Jay Bhattacharya stated, “We have now in our capacity the ability to actually end the HIV epidemic by 2030, to reduce HIV transmission to very, very low levels. And we just need to figure out how to do it” (Ryan, 2025). It is unclear how this goal can be achieved, given the massive amount of HIV treatment and prevention defunding that the Trump Administration and House Republicans wish to achieve. 

Regardless of the current destabilization in the HIV-related public health space, monitoring for transmission trends and cluster outbreaks is imperative. A challenging aspect of monitoring is HIV molecular surveillance. HIV molecular surveillance involves the collection and tracking of virus sequences from specific genetic strains of HIV. HIV transmission reporting is required by law for public health purposes. When a person tests positive for HIV, additional genetic bloodwork is done to determine the specific strain of HIV for epidemiological and cluster tracking purposes. 

In theory, meaningful data analysis is achieved by collecting this information. However, there are no proper safeguards in place to ensure the privacy of the PLWHA from whom this data is collected. Privacy breaches could result in harm, including economic and physical safety concerns. There are safer means of acquiring tracking data, such as tracking HIV through comprehensive case surveillance, behavioral and clinical monitoring, and analysis of pharmaceutical data (CDC, 2025). ADAP Advocacy is strongly opposed to HIV molecular surveillance being used to combat HIV clusters and has routinely supported the Center for HIV Law and Policy in its advocacy in this space.

Photo Source: Center for HIV Law & Policy

Data shows that some HIV transmission statistics are trending in the wrong direction. Now is not the time to destabilize the fragile infrastructure that is the status quo. If massive defunding ultimately becomes a permanent reality, HIV clusters will increase, and many preventable transmissions will occur. That outcome will result in a significantly higher level of societal and governmental spending compared to the savings the administration professes to achieve from its proposed fiscal cuts.

[1] Arum, C., Fraser, H., Artenie, A. A., Bivegete, S., Trickey, A., Alary, M., Astemborski, J., Iversen, J., Lim, A. G., MacGregor, L., Morris, M., Ong, J. J., Platt, L., Sack-Davis, R., van Santen, D. K., Solomon, S. S., Sypsa, V., Valencia, J., Van Den Boom, W., Walker, J. G., … Homelessness, HIV, and HCV Review Collaborative Group (2021). Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. The Lancet. Public health, 6(5), e309–e323. https://doi.org/10.1016/S2468-2667(21)00013-X. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8097637

[2] Budlon, K. (2025, July 11). Penobscot County HIV outbreak continues to grow; providers say the rest of Maine is at risk. Retrieved from https://www.mainepublic.org/health/2025-07-11/penobscot-county-hiv-outbreak-continues-to-grow-providers-say-the-rest-of-maine-is-at-risk

[3] Bush, B. (2025, January). Maine CDC change to syringe-exchange program in Bangor displaces need for services. Retrieved from https://www.newscentermaine.com/article/news/health/health-equity-alliance-syringe-needle-exchange-program-revoked-maine-cdc/97-f5132e6d-2c9f-405c-b034-cae05cd6de1c

[4] Centers for Disease Control and Prevention. (2025, February 7).About HIV Surveillance and Monitoring. Retrieved from https://www.cdc.gov/hiv-data/about/index.html#:~:text=Medical%20Monitoring%20Project%20(MMP):,outlets%20in%20the%20United%20States. 

[5] McCarthy, J. (2025, September 17). HIV cases have increased in Broome County cluster. Why there is still a 'big unknown'? Retrieved from https://www.pressconnects.com/story/news/public-safety/2025/09/17/hiv-cases-rise-in-ny-cluster-while-health-leaders-grapple-with-containment/86181140007/

[6] Peters, D. (2025, February 28). 'It's family here': Bangor officially closes city's largest homeless encampment. Retrieved from https://www.newscentermaine.com/article/news/local/bangor/bangor-closes-homeless-encampment-camp-hope-maine/97-00f3028d-4739-4ce9-b5fc-9287ab30e6ff#:~:text=Boyd%20Kronholm%2C%20executive%20director%20of%20the%20Bangor,approach%2D%2Drather%20than%20an%20immediate%20sweep%2D%2Dis%20more%20effective.

[7] Rupertus, A. (2025, July 28). Bangor syringe exchange service shuts down shortly after opening. Retrieved from https://www.bangordailynews.com/2025/07/28/bangor/bangor-health/needlepoint-sanctuary-shut-down-shortly-after-opening-n6hjn1me0n/

[8] Ryan, B. (2025, September 29). Republicans seek deep cuts to HIV prevention and treatment funding. Retrieved from https://www.msn.com/en-us/news/other/republicans-seek-deep-cuts-to-hiv-prevention-and-treatment-funding/ar-AA1NGD63?ocid=socialshare

[9] Tusinski, D. (2025, July 23). How a ‘cluster’ of HIV cases in Penobscot County became one of Maine’s largest outbreaks. Retrieved from https://www.pressherald.com/2025/07/23/how-a-cluster-of-hiv-cases-in-penobscot-county-became-one-of-maines-largest-outbreaks/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.    

Rural Health Transformation Program Offers Opportunity

By: Ranier Simons, ADAP Blog Guest Contributor

Budget reconciliation legislation, H.R. 1, also known as the "One Big Beautiful Bill Act," was signed into law in July of this year. The bill slashes overall Medicaid spending by $911 billion over ten years. This funding reduction would decrease Medicaid spending in rural areas by over $119 billion over the next ten years (Saunders, Burns, & Levinson, 2025). Medicaid covers one in four adults in rural areas, where 20% of the U.S. population resides. In response to the significant fiscal damage to rural areas resulting from H.R. 1, the bill includes a $50 billion fund known as the Rural Health Transformation Program (RHT). The $50 billion RHT is temporary, time-limited funding that does not remedy the over $119 million in cuts from H.R.1. However, it presents as an option to obtain a modicum of assistance to bolster rural programs.

Photo Source: CMS

To receive RHT funding, states must apply for a grant by submitting a Rural Health Transformation Plan. The RHT will distribute $10 billion annually from 2026 through 2030. Half of the funds will be distributed equally among the states that obtain approval of their transformation plans, and the remainder will be left to the discretion of CMS. The due date for applications is November 5, 2025, with a statutory deadline of December 31, 2025, for CMS to issue rewards (Howard et al., 2025). 

According to the Rural Health Transformation Program website, the program was created to “empower states to strengthen rural communities across America by improving healthcare access, quality, and outcomes by transforming the healthcare delivery ecosystem. In essence, the program is designed to stabilize and transform rural health systems nationwide by supporting infrastructure, workforce development, and innovative care delivery models. All comprehensive rural health transformation plans submitted with the funding application must include proposals that invest in at least three of the following areas (Karl et al.):

• Prevention and Chronic Disease: Implementing evidence-based, measurable interventions to improve prevention and chronic disease management. 
• Provider Payments: Supporting payments to providers for delivering healthcare services that fill a gap in care coverage (e.g., uncompensated care). 
• Consumer Technology Solutions: Expanding consumer-facing, technology-driven tools for chronic disease prevention and management.
• Training and Technical Assistance: Building capacity for adoption of technology-enabled solutions in rural hospitals. 
• Workforce: Recruiting and retaining clinicians in rural areas, with a minimum five-year service commitment. 
• IT Advances: Upgrading information technology at rural health facilities to improve efficiency and health outcomes. 
• Right-Sizing Care Availability: Helping rural communities align healthcare service lines (preventive, ambulatory, emergency, inpatient, post-acute) with community needs. 
• Behavioral Health: Expanding access to opioid-use disorder treatment, other substance-use disorder services, and mental healthcare. 
• Innovative Care Models: Supporting value-based care, alternative payment models, and other innovative delivery arrangements. 
• Capital Expenditures and Infrastructure: Investing in facility upgrades, minor renovations, and equipment to ensure sustainable operations. 
• Community Collaboration: Fostering partnerships between rural facilities and other providers to strengthen quality, financial stability, and access.

Photo Source: Shulkin Blog

Presently, numerous states are actively seeking public input on what projects and priorities they should consider in creating programs with which to utilize the funds they apply for. The following link indicates which states are presently receiving comments, as well as the official guidance on how to submit suggestions: Tracking State Preparation for the Rural Health Transformation Program. One state example is Louisiana, which created a landing page for its Request for Information (RFI). Notably, among the rural health challenges that need to be addressed, the Louisiana Department of Health directly highlighted HIV. The site specifies that 56% of new HIV cases are from outside of New Orleans and Baton Rouge. Georgia is another state that could benefit from funding for programs to address the needs of its rural population that is living with HIV. The results from a recently published paper indicate that significant disparities in HIV care access and support exist when comparing rural Georgians to those living in urban areas (Purcell et al., 2025).

As states create application proposals, it is imperative that they research all the fine details of what can and cannot be included. Prohibited uses of funds include support for new construction and building expansions, clinician salaries or wages at facilities with non-compete agreements, expenditures associated with financing the non-federal share of program costs, and requirements related to documenting citizenship (Karl et al., 2025). Given the current political climate, it is essential to navigate the application process with discernment while ensuring that a submitted plan aligns with all organizational goals.

As states submit plans, it would be very encouraging to see elements included that align with the Ending the HIV Epidemic (EHE) Initiative, increase capacity for HIV linkage to care in rural areas, and ways to improve rural PrEP access. Some rural hospitals have already closed, and the massive cuts in Medicaid spending threaten to close more. The RHT is a band-aid on a large wound that is more appropriate for stitches. However, in the status quo of rural healthcare, every dollar counts.

[1] Howard, H, Lopez, R., McLean, J, SHVS. (2025, September 18). Tracking State Preparation for the Rural Health Transformation Program. Retrieved from https://shvs.org/tracking-state-preparation-for-the-rural-health-transformation-program/

[2] Karl, A., Herring, A., Osius, L., Rains, J., Mannatt Health. (2025, September 17). CMS Releases Rural Health Transformation Funding Opportunity. Retrieved from https://shvs.org/wp-content/uploads/2025/09/CMS-Releases-Rural-Health-Transformation-Funding-Opportunity_SHVS.pdf

[3] Purcell, D. J., Standifer, M., Martin, E., Rivera, M., & Hopkins, J. (2025). Disparities in HIV Care: A Rural-Urban Analysis of Healthcare Access and Treatment Adherence in Georgia. Healthcare (Basel, Switzerland), 13(12), 1374. https://doi.org/10.3390/healthcare13121374

[4] Saunders, H., Burns, A., Levinson, Z. (2025, Jun 27). How Might the House-Passed Reconciliation Bill’s Medicaid Cuts Affect Rural Areas? Retrieved from https://www.kff.org/medicaid/how-might-the-reconciliation-bills-medicaid-cuts-affect-rural-areas/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.   

When is 'Enough' Going to Be Enough for Hospital CEOs?

By: Marcus J. Hopkins, ADAP 340B Consultant

Did you know?

Almost all but two of the ten highest-paying professions in the United States are in the medical field. The two professions that are not inherently medical in nature are airline pilots and Chief Executives. On the U.S. News list of the top ten jobs, Chief Executive salaries rank 10th, with a median annual salary of $206,680 (U.S. News, 2025).

Photo Source: Lown Institute

Apparently, U.S. News hasn’t met very many hospital CEOs. In particular, CEOs running the hospitals raking in millions of dollars from the lucrative 340B Drug Pricing Program—which is designed to help poor patients.

Hospitals are vital services filled with people who literally save lives every day, and at the top of the pile sits the Chief Executive Officer, ostensibly responsible for ensuring their hospital can keep the lights on and the patients alive and well. It’s a critical job that requires expertise and understanding of not only the healthcare space, but of business, management, finance, and publicity.

Of the 63 hospitals that ADAP Advocacy has audited since 2023, not a single CEO earned a salary so little as $206,680. Instead, across all 63 hospitals, the average CEO compensation package was $3,378,461—just a bit higher than the figure on the U.S. News list.

Now, obviously, U.S. News’ report considers all CEO positions across all sectors, but it raises the question of whether U.S. News needs to adjust its methodology.

It’s no secret that CEO pay at hospitals has long outpaced the incomes of the people working in those hospitals—people who often work significantly more extended hours and hold in their hands the literal lives of other human beings. In fact, a 2023 report from the North Carolina State Health Plan for Teachers and State Employees found that the CEO pay of just 11 of North Carolina’s non-profit hospitals was the equivalent of what those same hospitals would pay to hire 572 nurses (North Carolina State Health Plan for Teachers and State Employees, 2023).

The NC State Health Plan report highlights just how severe those pay gaps are, particularly at a time when wage growth for non-physician roles is slowing due to hospital system consolidation (Prager & Schmitt, 2021). More damning was that, during the COVID-19 pandemic, hospital CEOs gladly accepted exponential pay raises at these hospitals. In contrast, hospital staff—the individuals responsible for saving lives—were instructed to make do with insufficient supplies and personal protective equipment (Shabad, 2020).

Photo Source: North Carolina State Health Plan for Teachers and State Employees

The issue with CEO compensation, in general, is that CEOs tend to demand high compensation packages, particularly for companies and organizations that generate billions of dollars in revenue annually, and boards of directors often feel compelled to accept those demands. If they don’t want to pay that much, the candidate can simply walk away and find it elsewhere.

The non-physician employees who provide the bulk of care in hospitals don’t have that luxury.

Imagine if nurses and other hospital support staff demanded starting salaries of just $100,000 a year. They would be laughed out of the room, their demands would be rejected, and they would be accused of putting money ahead of patients. In fact, it wasn’t until 1974 that non-profit hospitals were allowed to form labor unions (National Labor Relations Board, n.d.), and even then, they could only do so if they agreed not to strike. 

When nurses strike, as with teachers, the argument is made that they are being selfish for striking. The criticism reflects: How DARE they put the lives of patients at risk?! Never mind that there have been critical nursing shortages for most of the past decade, and that shortage is expected to get considerably worse by 2030 (University of St. Augustine for Health Sciences, 2024). These shortages are driven by several factors, including (but not limited to):

• A rapidly expanding aging population, which grew from 41 million people in 2011 to 71 million in 2019 (a 73% increase; Paavola, 2020)
• An aging Registered Nurse (RN) population that is starting to retire, with more than 25% of all RNs saying in 2022 that they would leave or retire from the field within five years (Rosseter, 2024)
• Nurses not being located where the shortages are greatest
• Job stress, fatigue, and burnout (University of St. Augustine for Health Sciences, 2024)

Meanwhile, the CEO HCA Healthcare—the largest health system in the United States—gladly accepted a compensation package totaling $23,799,137, while the median HCA employee earns $60,082 (Brusie, 2025). This new compensation package increases the HCA CEO-to-worker pay ratio from 356 to 1 in 2023 to a staggering 391 to 1.

Photo Source: Vecteezy

The reality is that, while hospital CEOs have important jobs, they should never have become the stars of the show. Unfortunately, there are no data available that can demonstrate whether or not revenues received from the 340B Drug Pricing Program—a program created to ensure that poor patients were able to access low-cost medications and healthcare services by reinvesting those revenues into increasing access and affordability for those patients—have been used to increase the compensation packages of CEOs or other executives.

We argue that 340B dollars, regardless of the covered entity eligible to receive them, should be directly tied to improving access and affordability for patients. One way to improve services, for example, would be to use those funds to hire more nurses. Or increase the pay of the existing nurses. Or keep rural hospitals open instead of closing them and consolidating them.

There are a lot of moving parts in this debate, but the reality is that we’ve allowed CEO pay at 340B-eligible hospitals to get entirely out of hand. And if we don’t get a handle on the problem, soon, the companies that foot the bill—pharmaceutical companies—are going to refuse to participate.

References:

Brusie, C. (2025, May 05). HCA CEO pay gap widens in 2024; The eye-popping compensation of high-paid hospital CEOs. Bellevue, WA: Nurse.org: News. https://nurse.org/news/hospital-ceo-pay/

National Labor Relations Board. (n.d.). 1974 Health Care Amendments. Washington, DC: National Labor Relations Board: About NLRB: Who We Are: Out History. https://www.nlrb.gov/about-nlrb/who-we-are/our-history/1974-health-care-amendments

North Carolina State Health Plan for Teachers and State Employees. (2023, February 14). Hospital executive compensation: A decade of growing wage inequity across nonprofit hospitals. Raleigh, NC: North Carolina State Health Plan for Teachers and State Employees. https://www.shpnc.gov/nonprofit-hospital-executive-pay-report/open

Paavola, A. (2020, April 07). 266 hospitals furloughing workers in response to COVID-19. Chicago, IL: Becker’s Hospital Review: Finance. https://www.beckershospitalreview.com/finance/49-hospitals-furloughing-workers-in-response-to-covid-19/

Prager, E. & Schmitt, M. (2021). Employer consolidation and wages: Evidence from hospitals. American Economic Review, 111(2), 397-427. http://dx.doi.org/10.1257/aer.20190690

Rosseter, R. (2024, April). Nursing Workforce Fact Sheet. Washington, DC: American Association of Colleges of Nursing: News & Data: Fact Sheets. https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet

Shabad, A. (2020, May 04). North Carolina is low or completely out of certain critical supplies of PPE. WNCN Charlotte: Articles: News: Health: Coronavirus. https://www.wcnc.com/article/news/health/coronavirus/north-carolina-low-completely-out-critical-supplies-ppe/275-560d5b3e-172c-4e07-bf1d-f0e4524a5190

U.S. News. (2025). Best-Paying Jobs. Washington, DC: U.S. News: Money: Careers: Best Jobs: Best-Paying Jobs. https://money.usnews.com/careers/best-jobs/rankings/best-paying-jobs

University of St. Augustine for Health Sciences. (2024, December 30). Nursing shortage: A 2024 data study reveals key insights. St. Augustine, FL: University of St. Augustine for Health Sciences: Blog. https://www.usa.edu/blog/nursing-shortage/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Discontent and Lack of Trust Swirls Around RFK Jr

By: Ranier Simons, ADAP Blog Guest Contributor

Public health affects all Americans, regardless of their political ideology, religious beliefs, or socioeconomic background. The vast majority of the public also lacks an extensive medical or scientific background. Thus, citizens look to established institutions and entities for guidance on best health practices as they go about their busy lives. Consequently, the instability caused by the current state of upheaval in the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control & Prevention (CDC) is a public health hazard. The trust gap the average American has with RFK Jr. should not be trivialized, as it is having ripple effects throughout public discourse and the medical establishment.

Photo Source: STAT News

RFK Jr. has a very high-profile stance that many describe as being anti-vaccine. Although he does not hold a medical degree and has no prior experience as an environmental attorney, he has characterized the historically internationally respected CDC as a corrupt institution that has failed the American public (Soucheray, 2025). This sentiment is especially notable in his characterizations of COVID-19 vaccines and childhood vaccinations. Scientific data show that COVID-19 vaccinations worldwide prevented approximately 2.5 million deaths between December 2020 and October 2024 (John et al., 2025). Statistics such as this significantly damage his credibility.

A recent poll, conducted by The Economist and YouGov and surveying 1,691 adults, indicated that only one in four Americans trusts RFK Jr. with medical advice (Crisp, 2025). Approximately 51% of respondents stated they still trust CDC guidance, and 79% stated they trust the medical recommendations of their personal physicians (Crisp, 2025). Notably, 45% expressed disapproval of Kennedy’s job as HHS secretary.

Experienced career staff at HHS have also raised questions about RFK Jr.’s trustworthiness. A recent shooting at the CDC resulted in six CDC buildings sustaining damage and one police officer being killed (Fields, 2025). 

In response, on August 20th, over 750 current and former HHS staff members issued a letter addressed to HHS Secretary Kennedy and Congress asking him to stop spreading inaccurate health information. The letter expressed that, “The attack came amid growing mistrust in public institutions, driven by politicized rhetoric that has turned public health professionals from trusted experts into targets of villainization—and now, violence…Health and Human Services Secretary Robert F. Kennedy, Jr., is complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information…”.

Photo Source: STAT News

On September 3rd, over 1000 current and former HHS staff released another letter asking him to resign. The public cannot foster trust in the head of HHS when internal members of HHS are calling for his resignation.

Even amidst the recent outbreak of measles, RFK Jr.'s stance on childhood vaccines is fostering conflicting messaging and confusion. Recently, Florida’s Surgeon General announced that the state would be the first to end all vaccine mandates, including those for schoolchildren (Kearney, 2025). For years, all 50 states and the District of Columbia have had laws requiring school children to be vaccinated against diseases such as polio and measles. Despite the Florida Surgeon General’s announcement, a recent survey conducted by The Washington Post and the Kaiser Family Foundation (KFF) indicates 82% of Florida parents support public schools requiring vaccines for measles and polio, with some health and religious exemptions. Comparatively, 81% of parents nationwide also support school vaccine requirements.

In June of this year, HHS Secretary Kennedy fired all 17 members of the Advisory Committee on Immunization Practices (ACIP) (Stone, 2025). This committee helps develop vaccine policy and recommendations for the CDC. Kennedy stated that he removed all the members because he felt they all had conflicts of interest, as indicated in a government report (Huang, 2025). However, it has been documented that Kennedy’s interpretation of the report is inadequate, given that it is almost twenty years old, dating back to 2009. Dr. Tom Frieden, CDC director from 2009 to 2017, publicly stated Kennedy was giving “a total misrepresentation of a 20-year-old report, about a process that was already being improved before that report was issued” (Huang, 2025). Secretary Kennedy subsequently replaced the old members with several individuals who had previously expressed anti-vaccine sentiments.

Out of grave concern for public health, the American Academy of Pediatrics (AAP) recently published its own 2025 recommended schedule for child and adolescent immunization, which differs from the current CDC's ACIP (Gerlach, 2025). The AAP is outwardly challenging the current CDC guidelines, stating its recommendations are evidence-based. Susan J. Kressly, MD, AAP president, said in a statement, “The AAP will continue to provide recommendations for immunizations that are rooted in science and are in the best interest of the health of infants, children, and adolescents” (Gerlach, 2025). She added, “Pediatricians know how important routine childhood immunizations are in keeping children, families, and their communities healthy and thriving” (Gerlach, 2025). Among the significant divergences from CDC ACIP guidance, the AAP recommends universal COVID-19 vaccination for children aged 6 to 23 months and risk-based immunization for children aged 2 to 18 years, such as those who are medically vulnerable or living with high-risk individuals (Gerlach, 2025).

Photo Source: ABC30

Some Democrat-led states are also pushing back against the current CDC ACIP advisories. Massachusetts recently became the first state to issue its own vaccine rules. Governor Maura Healey announced that health insurers doing business in Massachusetts will be required to cover vaccines recommended by the state health department, regardless of whether the CDC recommends them or not. Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans support the policy (Goldman, 2025 Sept.4) California, Oregon and Washington have formed what is being called the West Coast Health Alliance to issue their own vaccine recommendations to battle the politicization of the CDC (Goldman, 2025 Sept.3). New Mexico recently through its health department issued and order that all its residents can obtain COVID-19 vaccinations even though Kennedy announced they should be restricted to high-risk patients (Goldman, 2025, September 5).

Just this week, PlusInc – an organization promoting health equity – issued a strongly worded rebuke of RFK Jr's assertion that there is a definitive link between Tylenol and autism. The statement, in part, reads: "Monday’s disorganized pronouncement was made with either complete unawareness or discounting of findings from a study published just last year in JAMA Network that found no link between the use of acetaminophen and children’s risk of autism, attention-deficit/hyperactivity disorder (ADHD), or any intellectual disabilities."

Distrust in RFK Jr’s leadership is adversely disruptive to public health and problematic for the evidence-based established infrastructure of medical science. Moreover, since states have the legal latitude to create their own health policies and guidance, the result could lead to a patchwork quilt of public health protections that vary from state to state. The public will ultimately be left with apprehension regarding health decisions, and states may face retaliatory funding responses from the federal government. The trust gap between RFK Jr. and the American public is not merely an issue of political theater, but a threat to the lives of citizens.

[1] Crisp, E. (2025, September 3). 1 in 4 Americans trust RFK Jr. with medical advice. Retrieved from https://thehill.com/policy/healthcare/5484579-kennedy-poll-medical-advice/

[2] Fields, A. (2025, August 12). 500 shots fired in CDC attack in Atlanta. Retrieved from https://thehill.com/homenews/state-watch/5447797-gunman-cdc-headquarters/

[3] Gerlach, A. (2025, August 21). American Academy of Pediatrics Releases 2025 Child, Adolescent Immunization Recommendations. Retrieved from https://www.pharmacytimes.com/view/american-academy-of-pediatrics-releases-2025-child-adolescent-immunization-recommendations

[4] Goldman, M. (2025, September 4). Massachusetts becomes first state to impose its own vaccine coverage rules. Retrieved from https://www.axios.com/2025/09/04/massachusetts-vaccine-coverage-rules

[5] Goldman, M. (2025, September 3). 3 western states form vaccine alliance to counter feds. Retrieved from https://www.axios.com/2025/09/03/cdc-vaccine-washington-california-oregon-guidelines-recommendations

[6] Goldman, M. (2025, September 5). Blue states eye rival health rules to defy RFK Jr.. Retrieved from https://www.axios.com/2025/09/05/rfk-vaccine-rule-states-democrats-vaccine-rules

[7] Huang, P. (2025, March 11). RFK says most vaccine advisers have conflicts of interest. A report shows they don't. Retrieved from https://www.npr.org/sections/shots-health-news/2025/03/11/nx-s1-5323771/rfk-jr-vaccine-advisers-conflicts-interest

[8] John, Pezzullo, A. M., Cristiano, A., & Boccia, S. (2025). Global Estimates of Lives and Life-Years Saved by COVID-19 Vaccination During 2020-2024. JAMA Health Forum, 6(7), e252223–e252223. https://doi.org/10.1001/jamahealthforum.2025.2223

[9] Kearney, A. (2025, September 4). Most Parents Nationally and in Florida Want Schools to Require Vaccines. Retrieved from https://www.kff.org/quick-take/most-parents-nationally-and-in-florida-want-schools-to-require-vaccines/

[10] Soucheray, S. (2025, September 4). In heated Senate committee meeting, RFK Jr says fired CDC chief lied about ouster. Retrieved from https://www.cidrap.umn.edu/anti-science/heated-senate-committee-meeting-rfk-jr-says-fired-cdc-chief-lied-about-ouster#:~:text=During%20the%203%2Dhour%20meeting,see%20today's%20CIDRAP%20News%20story).

[11] Stone, W. (2025, June 9). RFK Jr. boots all members of the CDC's vaccine advisory committee. Retrieved from https://www.npr.org/sections/shots-health-news/2025/06/09/nx-s1-5428533/rfk-jr-vaccine-advisory-committee-acip#:~:text=boots%20all%20members%20of%20the%20CDC's%20vaccine%20advisory%20committee,-Listen%C2%B7%203:25&text=Secretary%20of%20Health%20Robert%20F,issue%20statements%20denouncing%20the%20move

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.