The Growing Access Barrier Facing Patients: Private Equity

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

The acquisition of hospitals and healthcare practices by private equity (PE) firms has increased dramatically over the past two decades, with PE deals involving healthcare businesses tripling from 2009 to 2016, and acquisitions of healthcare-related operations reaching a staggering $79 in 2019 (Halabi et al., 2025). This explosive growth in acquisitions has resulted in astonishing profits for PE firms, slashed salaries for PE-owned employees, and worse outcomes for patients.

Photo Source: Purchaser Business Group on Health

According to the Private Equity Stakeholder Project (PESP), approximately 488 hospitals in the U.S. are owned by PE firms, including 8.5% of all private hospitals and 22.6% of all proprietary for-profit hospitals. At least 27.7% of PE-owned hospitals serve primarily rural patients, and nearly a quarter (22.6%) of PE-owned facilities are psychiatric hospitals (PESP, 2025b).

The healthcare sector is particularly attractive to PE firms as healthcare spending accounts for nearly one-sixth (18%) of the U.S. gross domestic product (GDP), growing 7.2% in 2024, and reaching $5.3 trillion or $15,474 per person (CMS, 2026). With spending at those levels, PE firms can very easily increase profitability, which they largely achieve by decreasing expenditures, particularly those related to salaries, and increasing the number of services provided and billed.

Research published in the Annals of Internal Medicine found that emergency department salaries were cut by 18.2% compared with control hospitals, by 15.9% in intensive care units (ICUs), and by 16.6% hospital-wide, reducing the number of full-time hospital employees by 11.6% (Kannan et al., 2025).

These cuts in staffing come with a cost. Using Medicare Part A and B claims and Cost Report data from 2009-2019, Kannan et al. found that, while there was no observable increase in ICU mortality rates, deaths in PE-owned emergency departments increased by 13.4%. In addition, patient transfers to other acute care hospitals from emergency departments increased by 4.2% and from ICUs by 10.6% (Kannan et al., 2025).

Photo Source: PESP Private Equity Hospital Tracker

A study published in Health Affairs found that claims billed by PE-owned hospitals to Medicare increased by 30.5% after acquisition, resulting in a 14.9% increase in Medicare spending per physician over five quarters. Similarly, patients at PE-acquired primary care practices saw a 12.9% increase in the number of services received, including an 11.1% increase in laboratory tests and an 11.3% increase in preventive and screening services (Singh et al., 2026).

These increases in services, when combined with significant decreases in salaries and staffing, result in huge profits for PE firms just from Medicare payments alone. It is harder, however, to quantify any increases in revenues related to the 340B drug pricing program at these practices or hospitals for a few of reasons:

• According to the Private Equity Stakeholder Project (PESP), some hospitals are operated by PE firms through complex ownership structures, often masking who owns, operates, or oversees them (PESP, 2025b).
• Some non-profit hospitals, while not directly owned by PE firms, are managed by companies that are owned by PE firms. Many of these arrangements are not publicly disclosed (PESP, 2025b);
• Providers are not currently required by either the Health Resources & Services Administration (HRSA), the Center for Medicare & Medicaid Services (CMS), or the Internal Revenue Service (IRS) to report annual 340B revenues to the public or on any tax documents.

That does not, however, mean that PE firms don’t have 340B in their sights. In May 2026, Quorum Health, based in Brentwood, TN, announced that they would be abandoning their for-profit business model and switching to a non-profit model under the pretense of ‘…deliver[ing] quality care in rural and mid-sized communities.” Quorum admits that doing so will result in $13 million in annual savings from tax exemptions alone, and that the expected acquisition of eligibility for the 340B Program will result in $11 million in additional revenues. While this shift must be approved by regulators, it’s expected to be approved by Fall 2026 (Van Alstin, 2026).

These negative consequences have not gone unnoticed. The Private Equity Stakeholder Project—a Chicago-based non-profit watchdog organization founded in 2017 to monitor and address the growing impact of private equity and private fund managers in the climate & energy, workers & jobs, housing, healthcare, and detention & surveillance industries (PESP, n.d.)—began tracking hospitals owned by PE firms, creating an easily searchable list for public examination (PESP, 2025a) and an interactive map (PESP, 2025b).

Photo Source: Quartz

While nonprofit organizations and researchers are closely monitoring the impacts of PE firm ownership in the healthcare industry, state and federal legislators and regulators have struggled to keep pace with the pace of PE acquisitions. A recent article published in The American Journal of Managed Care has called on policymakers to “…pursue innovative regulatory solutions, including health care–specific PE law, alignment of state and federal oversight, adoption of alternative payment models, and strengthened patient protections against PE-associated clinical and nonclinical risks (Berman et al., 2026).

ADAP Advocacy echoes this call. Aside from the risks to patients, PE firms represent real and present dangers to the communities being served by the providers and hospitals they own and loot. They raid safety-net hospitals (O’Grady, 2022), bankrupt hospitals and sell off their property (DePillis, 2019), roll back or eliminate essential but less profitable services (Spegele, 2021), and leave communities with few, if any, options for accessing healthcare services. Those PE firms that have managed to worm their way into the non-profit provider sectors are also very likely reaping 340B revenues while patients suffer.

It’s time to curtail PE ownership in the healthcare sector, regardless of how much money it makes for owners and investors.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

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

References:

[1] Berman, M. E., Tamirisa, K., Rahim, F. O., Khachadoorian-Elia, H., & Witkowski, M. L. (2026, May 11). Regulating Private Equity in Health Care: A Strategic Policy Agenda. American Journal of Managed Care, 32(5), e138-e140. https://doi.org/10.37765/ajmc.2026.89938

[2] Centers for Medicare and Medicaid Services. (2026, January 14). National health expenditure data: Historical. Washington, DC: United State Department of Health and Human Services: Centers for Medicare and Medicaid Services: Data and Research: Statistics, Trends, and Reports: National Health Expenditure Data. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical

[3] DePillis, L. (2019, July 29). Rich investors may have let a hospital go bankrupt. Now, they could profit from the land. Atlanta, GA: CNN: CNN Business: Economy. https://www.cnn.com/2019/07/29/economy/hahnemann-hospital-closing-philadelphia/index.html

[4] Halabi, S., Belani, S., & O’Hara, G. (2025). Private Equity and Non-Profit Status in the US Healthcare System. Akron Law Review, 58(4), 687-715. https://ideaexchange.uakron.edu/akronlawreview/vol58/iss4/4?utm_source=ideaexchange.uakron.edu%2Fakronlawreview%2Fvol58%2Fiss4%2F4&utm_medium=PDF&utm_campaign=PDFCoverPages

[5] Kannan, S., Bruch, J. D., Zubizarreta, J. R., Stevens, J., & Song, Z. (2025, September 23). Hospital Staffing and Patient Outcomes After Private Equity Acquisition. Annals of Internal Medicine, 178(11), 1,528-1,538. https://doi.org/10.7326/ANNALS-24-03471

[6] O’Grady, S. (2022, November). How Private Equity Raided Safety Net Hospitals and Left Communities Holding the Bag: A Case Study on Leonard Green & Partners’ Ownership of Prospect Medical Holdings. Chicago, IL: Private Equity Stakeholder Project: PESP Private Equity Hospital Tracker. https://pestakeholder.org/wp-content/uploads/2022/11/Prospect_Primer_Nov-2022.pdf

[7] Private Equity Stakeholder Project. (2025a, April). PE hospital tracker. Chicago, IL: Private Equity Stakeholder Project: PE Hospital Tracker. https://airtable.com/appZYwbt3vioNrb95/shricxhAQSjpv5ec8/tbl058jjL6qNMqzkM

[8] Private Equity Stakeholder Project. (2025b, April). PESP Private Equity Hospital Tracker. Chicago, IL: Private Equity Stakeholder Project. https://pestakeholder.org/pesp-private-equity-hospital-tracker/

[9] Private Equity Stakeholder Project. (n.d.). About us. Chicago, IL: Private Equity Stakeholder Project: About Us. https://pestakeholder.org/about-us/

[10] Singh, Y., Dixit, M. N., & Whaley, C. M. (2026, May 20). Private Equity Acquisitions In Primary Care: Changes In Utilization, Spending, And Workforce. Health Affairs, 45(6), 629-636. https://doi.org/10.1377/hlthaff.2025.01703

[11] Spegele, B. (2021, April 11). A City’s Only Hospital Cut Services. How Locals Fought Back. New York, NY: The Wall Street Journal: Health: Healthcare. https://www.wsj.com/health/healthcare/a-citys-only-hospital-cut-services-how-locals-fought-back-11618133400

[12] Van Alstin, C. (2026, May 24). Nationwide private-equity backed hospital chain announces shift to nonprofit business model. Providence, RI: Innovate Healthcare: Health Exec: Business Intelligence. https://healthexec.com/topics/healthcare-management/business-intelligence/nationwide-private-equity-backed-hospital-chain-announces-shift-nonprofit-business-model

HIV Advocacy: Why Stories Change More Than Hearts

By: Michelle Anderson, MA, Grassroots Advocacy & Patient Storytelling Consultant, ADAP Advocacy

**First-Person Perspectives**

I have been in advocacy for more than 20 years, and for years, I have sat in rooms where decisions were being made for people like me without including people like me in the conversation. I have listened to presentations filled with statistics, charts, and research findings that spoke completely over my head. I have listened to reports that described the disparities affecting Black women living with HIV, but those reports were not always an accurate depiction because they did not provide a complete narrative of Black women's experiences when faced with the systemic pressures that create risk for HIV beyond behavior. Although the data is important and research matters, something is still missing.

Photo Source: Narrative Power Institute

I often say that stories are more than personal experiences. They are a form of knowledge that speaks beyond what data cannot convey. They help us understand how policies, systems, and institutions impact real lives. They reveal the human reality behind data and create opportunities for change that numbers alone often cannot achieve because they connect the numbers to human impact.

For instance, when a Black woman living with HIV shares her experiences, it brings context to the conversation. It helps people understand that HIV is not a single issue. It is often connected to issues like poverty, trauma, housing insecurity, gender-based violence, lack of healthcare access, and systemic racism. These are realities that cannot be fully captured in a report because statistics only tell the story of the disproportionate impact of HIV.

Storytelling makes systems visible. It helps us move away from stigmatizing rhetoric that blames individuals and toward examining the conditions that shape people's realities. Instead of asking why someone did not make a different choice, storytelling helps us understand why the decision was made, given the options available to them and the conditions that shaped those options.

I have seen firsthand how stories can change a room. I have watched policymakers lean in when they hear someone describe the choice between paying rent and paying for healthcare. I have seen healthcare providers reconsider their assumptions after listening to a patient who may have fallen out of care due to transportation barriers. I have watched community members connect with issues they previously viewed as distant or unrelated to their own lived experiences. Stories create understanding, empathy, accountability, and, most importantly, they create movement.

Photo Source: ADAP Advocacy

That same principle is at the heart of the work currently underway through the "ADAP Saves Lives: End the Wait" campaign, which was launched in response to the reemergence of ADAP waiting lists and restrictions in some parts of the country. For those of us who have been in this fight nearly 20 years ago, the thought of people once again waiting for access to life-saving HIV medication is deeply concerning. Storytelling is an essential advocacy tool because behind every policy decision is a person whose health may be affected. By elevating the voices of persons living with HIV, storytelling helps policymakers and communities understand what is truly at stake when access to care is threatened.

Meaningful Involvement of People Living with HIV/AIDS (MIPA) recognizes that people living with HIV should be involved, utilizing our lived expertise as leaders, decision makers, and partners in shaping the policies and programs that impact our lives. When people share their experiences in legislative hearings, advisory boards, advocacy campaigns, and community discussions, they provide evidence-informed solutions grounded in real-time experiences. This is when narrative begins to build power.

Narrative power is the ability to shape how people understand an issue. It is the ability to influence systems by challenging stigma, exposing data gaps, and moving conversations beyond awareness to impact. By shifting the narrative, our stories change perspectives, influence policy, and become the power that shapes how systems operate and whose voices are valued within them.

Photo Source: ADAP Advocacy

I believe that the people closest to the issues are often closest to the solutions. Lived experiences belong at decision-making tables because stories are more than personal testimonies. They are tools for leadership, advocacy, and systems change. Stories do change hearts, but they also change how people understand issues, how policies are shaped, and how systems respond to the communities they serve.

Stories do change hearts, but the power does not stop there. They help people understand, in real time, the realities behind data and the impact systems have on people’s lives. When we share our stories, we are challenging stigma, educating communities, informing policy, and creating opportunities for change. We move beyond awareness and into action. We transform our lived experiences into narrative power. This month marks the beginning of ADAP Advocacy’s narrative power to combat the resurgence of those dreading AIDS Drug Assistance Program waiting lists. Patient’s lives depend on it!

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

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

Gonorrhea is the Chink in DoxyPEP's Armor

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Recent studies have shown that DoxyPEP (doxycycline post-exposure prophylaxis) is becoming less effective against the bacterial sexually transmitted infection (STI) gonorrhea. Concerns are rising among certain public health groups, such as the Centers for Disease Control & Prevention and European counterparts, but Doxy-PEP remains regarded as a highly effective prevention method for high-risk groups.

Photo Source: Harvard Health Publishing

For the uninitiated, DoxyPEP is a post-exposure oral medication provided within 72 hours after a sexual encounter that reduces the likelihood of acquiring bacterial STIs, including syphilis, chlamydia, and gonorrhea. In the initial DoxyPEP trial, researchers found that the incidence of syphilis decreased by 87%, chlamydia by 88%, and gonorrhea by 55% (Dall, 2026). After this initial study, the Centers for Disease Control and Prevention (CDC) released clinical guidelines for its utilization in 2024 (Bachmann et al., 2024).

Even in the initial study, the reduced incidence of gonorrhea was modest, at best; subsequent studies have shown that a rapid increase in tetracycline-resistant strains of gonorrhea has greatly reduced or all but eliminated DoxyPEP’s efficacy against the infection.

Research published in JAMA Internal Medicine found that the incidence of STI cases of syphilis and chlamydia in San Francisco, CA, decreased significantly among Men who have Sex with Men (MSM) and transgender women against projected case numbers, while the incidence of gonorrhea increased significantly (Sankaran et al., 2025).

Another study published in Clinical Infectious Diseases suggests that widespread utilization of DoxyPEP may actually be contributing to the increase in tetracycline-resistant gonorrhea strains in King County, Washington state, which has resulted in the county health department revising its guidelines on the utilization of doxycycline to treat other bacterial issues, including skin and soft tissue infections and lower respiratory tract infections (Soge et al., 2025).

A third study published in The Lancet Infectious Diseases similarly suggests that widespread utilization of DoxyPEP may be inadvertently increasing the propagation of multidrug-resistant strains of gonorrhea in southern California (Yechezkel et al., 2026).

Photo Source: emedicinehealth.com

Drug-resistant strains of gonorrhea have been a concern in the United States for some time, and researchers have been sounding the call against overreliance upon DoxyPEP as a harm reduction tool against the STI for just as long. A correspondence published in the New England Journal of Medicine in 2025 warned that multidrug-resistant strains have been spreading globally, including strains that carry resistance to the antibiotic ceftriaxone (Helekal et al., 2025).

Sexual health advocates have been heralding DoxyPEP as one of the first effective methods for preventing STIs transmission since the findings of the initial study, including those at the American Sexual Health Association (ASHA, 2025). There is no doubt that DoxyPEP has clearly been shown to be effective against syphilis and chlamydia; however, ADAP Advocacy recommends that organizations begin having realistic conversations about its efficacy against, as well as the continued increase in propagation of, multidrug-resistant strains of gonorrhea.

These conversations need not be “sex-negative,” focusing on fear and shame-based representations of sexual activity; they do, however, need to be realistic.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

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

References:

[1] American Sexual Health Association. (2025, May 09). Learn More About Doxy PEP from Three People Who Take It. Research Triangle Park, NC: American Sexual Health Association. https://www.ashasexualhealth.org/learn-more-about-doxy-pep-from-three-people-who-take-it/

[2] Bachmann, L. H., Barbee, L. A., Chan, P., Reno, H., Workowski, K. A., Hoover, K., Mermin, J., & Mena, L. (2024, June 06). CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. Morbidity and Mortality Weekly Report Recommendations and Reports, 73(2): 1-8. http://dx.doi.org/10.15585/mmwr.rr7302a1

[3] Dall, C. (2026, May 11). Study shows doxyPEP’s diminished effectiveness against gonorrhea. Minneapolis, MN: University of Minnesota: Research and Innovation Office: Center for Infectious Disease Research and Policy: Antimicrobial Stewardship. https://www.cidrap.umn.edu/antimicrobial-stewardship/study-shows-doxypep-s-diminished-effectiveness-against-gonorrhea

[4] Helekal, D., Mortimer, T. D., & Grad, Y. H. (2025, July 09). Expansion of tetM-Carrying Neisseria gonorrhoeae in the United States, 2018–2024. New England Journal of Medicine, 393(2), 198-200. https://doi.org//10.1056/NEJMc2504010

[5] Sankaran, M., Glidden, D. V., Kohn, R. P., Nguyen, T. Q., Bacon, O., Buchbinder, S. P., Gandhi, M., Havlir, D. V., Liebi, C., Luetkemeyer, A. F., Nguyen, J. Q., Roman, J., Scott, H., Torres, T. S., & Cohen, S. E. (2025, January 06). Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infection Trends. JAMA Internal Medicine, 185(3), 266-272. https://doi.org/10.1001/jamainternmed.2024.7178

[6] Soge, O. O., Thibault, C. S., Cannon, C. A., McLaughlin, S. E., Menza, T. W., Dombrowski, J. C., Fang, F. C., & Golden, M. R. (2025, June). Potential Impact of Doxycycline Post-Exposure Prophylaxis on Tetracycline Resistance in Neisseria gonorrhoeae and Colonization With Tetracycline-Resistant Staphylococcus aureus and Group A Streptococcus. Clinical Infectious Diseases, 80(6), 1,188-1,196. https://doi.org/10.1093/cid/ciaf089

[7] Yechezkel, M., Helekal, D., Kapadia, B., Hong, V., Pomichowski, M. E., Reyes, I. A. C., Davis, G. S., Müller, N. F., Grad, Y. H., Tartof, S. Y., & Lewnard, J. A. (2026, May 07). Durability of doxycycline effectiveness against gonorrhoea after implementation of post-exposure prophylaxis in southern California, USA: a retrospective, test-negative, observational study. The Lancet Infectious Diseases. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00123-4/fulltext

National Oncology Group Realigns 340B Priorities Away from Patient-First

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

The American Society of Clinical Oncology (ASCO) released its latest policy position statement on the 340B Drug Pricing Program on May 5th, 2026 (ASCO, 2026). ASCO President, Eric J. Small, MD, FASCO, states, “…reforms focused on eligibility, transparency, and accountability are needed to reflect modern healthcare delivery and to ensure the program continues to benefit the vulnerable people it was designed to help.” But why?

Despite this statement, some of their new positions have raised eyebrows among 340B reform advocates, staking out positions that seem less designed to deliver on transparency and accountability, and more aligned with profitability. Ted Okon, who serves as the executive director of the Community Oncology Alliance, and Dr. Lucio Gordan, a medical oncologist and hematologist with Florida Cancer Specialists & Research Institute, expressed their disagreement in a strongly worded op-ed published in The Wall Street Journal only days after ASCO’s announcement, which reads, in part:

“Expanding participation in a flawed program isn’t reform. It simply broadens access to the same distorted financial incentives that have fueled consolidation, higher costs and migration of cancer care into more expensive hospital settings.”

Photo Source: The Wall Street Journal

One ASCO’s “new” positions involve the proliferation of child sites—standalone locations affiliated with a larger healthcare provider but not on its main campus.

In its statement, ASCO asserts that, “Independent oncology practices with multiple locations should be able to register a child site for the 340B program if they bill under the same Tax ID number as the eligible parent practice.”

The problem with this is that child sites are not always located in areas that serve the populations that 340B covered entities are obligated to serve: lower-income, uninsured, and underinsured patients.

For example, Bon Secours Mercy Health’s Richmond Community Hospital in Richmond, VA, closed its intensive care unit in 2017, yet it still managed to have the highest profit margins of any hospital in Virginia. While cutting services and supplies, former Bon Secours executives, doctors, and nurses accused the company of reaping the 340B revenue profits from communities like Richmond and reinvesting them in wealthier—and Whiter—communities (Thomas & Silver-Greenberg, 2022).

Photo Source: ADAP Advocacy

Proving this, however, is difficult when it comes to hospital systems, as there are zero public reporting requirements for 340B revenues for hospitals, and it becomes even more labyrinthine when 340B eligibility is extended across child sites.

ADAP Advocacy argues that each child site should be able to prove its eligibility on its own merits, without those revenues being redirected to a larger organization that can then redistribute those funds to areas outside the 340B remit.

Another area where ASCO runs its transparency argument afoul relates to its call to allow unlimited numbers of contract pharmacies:

“Covered entities should be able to contract with multiple pharmacies, with caps on administrative fees, to support rural and underserved areas and ensure savings are preserved for patient care.”

The recent explosion in the number of covered entities and contract pharmacies has exacerbated the issue of manufacturers encountering duplicate discounts. Duplicate discounts occur when drugs provided to Medicaid beneficiaries (i.e., patients) are subject to discounted prices under the 340B program and are also eligible for Medicaid rebates—when drug manufacturers pay rebates to states as a condition for the federal contribution to Medicaid spending for the manufacturers’ outpatient drugs (Nguyen & Suresh, 2024). This overlap means manufacturers risk providing duplicate discounts when they are legally required to provide either a 340B program drug price or a rebate to state Medicaid programs (Health Resources & Services Administration, 2020).

Photo Source: HRSA | Paul Shank

To combat this risk, the U.S. Department of Health and Human Services (HHS) and CMS created the Medicaid Exclusion File (MEF)—a list of covered entities that use 340B drugs for Medicaid beneficiaries under the Fee-For-Service (FFS) model. Once registered on the MEF, covered entities must notify the agency if they intend to use 340B drugs for Medicaid beneficiaries, and states then exclude claims from those registered providers from their rebate invoices to manufacturers.

The problem, however, is that the MEF applies only to FFS Medicaid models, and not to Medicaid MCOs. Unlike FFS models, which are based on reimbursement for individual services, MCOs are generally paid under a capitated model that pays each plan a set amount per beneficiary each month. As states increasingly contract with MCOs to manage their state Medicaid benefits, the expansion of drug dispensing by contracted pharmacies under the MCO model makes it more difficult for states to identify patients covered by MCOs and to track whether a 340B-discounted drug was dispensed to those patients (Nguyen & Suresh, 2024).

In addition to these changes, ASCO also proposes a new eligibility formula, called the Indigent Care Ratio (ICR). This ratio, they argue, would allow 340B eligibility to be extended to community-based, non-hospital-affiliated providers, such as independent oncology practices:

More than half of Americans receive cancer care in community-based oncology practices,” said Dr. Small. “These practices form the backbone of cancer care delivery in many rural and underserved areas, where they are often patients’ only access to such care (ASCO, 2026).

Using an ICR, ASCO argues, would allow practices to meet a specific threshold for providing care to Medicaid, uninsured, and dual-eligible patients. While the ICR makes sense in theory, its impacts definitely need further study before any implementation. ADAP Advocacy is concerned that this proposed formula, like most other formulas designed to expand access under the 340B Program, will run amok by entities trying to scheme profitability. It could further compound an existing problem by driving up the cost of cancer care, as “the current financial incentives within the 340B program may be driving higher utilization of specific outpatient medications” (Access Forum, 2026).

Photo Source: American Journal of Managed Care

There is significant overlap in advocacy values and policy priorities between the HIV and oncology patient communities, fostering greater collaboration. It has led to greater alignment on key issues, such as protecting Medicare’s six protected classes, outlining concerns about the adverse impact of Medicare’s Drug Pricing Negotiation Program on patient access, and reforming the 340B Program. In each case, that alignment has maintained one paramount priority: patients. Sadly, ASCO’s revised 340B priorities fall outside of that patient-first priority.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

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

References:

[1] Access Forum. (2026, February 15). The Hidden Cost of 340B: How Drug Pricing Programs Impact Cancer Care. https://theaccessforum.org/learning-hub/the-hidden-cost-of-340b-how-drug-pricing-programs-impact-cancer-care/ 

[2] American Society of Clinical Oncology. (2026, May 05). ASCO Updates Policy Statement on 340B Drug Pricing Program. Alexandria, VA: American Society of Clinical Oncology: News & Initiatives: Policy New Analysis. https://www.asco.org/news-initiatives/policy-news-analysis/asco-updates-policy-statement-340B-drug-pricing-program

[3] Health Resources and Services Administration. (2020, July). Duplicate Discount Prohibition. Washington, DC: United States Department of Health and Human Services: Health Resources Services Administration: 340B Drug Pricing Program: Program Requirements: Duplicate Discount Prohibition. https://www.hrsa.gov/opa/program-requirements/medicaid-exclusion

[4] Nguyen, T. & Suresh, R. (2024, March 04). What You Need to Know About 340B Duplicate Discounts. Washington, DC: Edgeworth Economics: The Antitrust Prescription. https://www.edgewortheconomics.com/antitrustprescription-340B-duplicate-discounts

[5] Okon, T. & Gordan, L. (2026, May 15). Expanding 340B Won’t Fix a Broken System. The Wall Street Journal. https://www.wsj.com/opinion/expanding-340b-wont-fix-a-broken-system-8c621229?st=BPngEs&reflink=desktopwebshare_permalink 

[6] Thomas, K. & Silver-Greenberg, J. (2022, September 24). How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits. New York, NY: The New York Times: Health. https://www.nytimes.com/2022/09/24/health/bon-secours-mercy-health-profit-poor-neighborhood.html

HealthHIV Releases State of Aging with HIV Survey Results

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

HealthHIV has released its fifth annual survey on the State of Aging with HIV™, finding both positive and negative results from patients and providers alike. This report details survey findings and implications across five areas: HIV and Geriatric Care, Comorbidities, Behavioral Health, Access and Payment, and Workforce.

HealthHIV summarized the survey as follows:

"The survey revealed an HIV care system that delivers clinical wins. Over 98% of consumers reported being virally suppressed, and nearly 100% are taking antiretrovirals, the highest rates across five waves of the survey. The same data, however, show that the broader clinical reality of aging with HIV, multimorbidity, frailty risk, mental health burden, and the structural conditions of daily life, is not being managed with the same consistency."

Photo Source: HealthHIV

Key findings include:

Viral Suppression is High Among Older People Living with HIV/AIDS

Among People Living with HIV/AIDs (PLWHA) surveyed, 98% reported that their HIV was virally suppressed. This is significantly better than the national average of 62% (CDC, 2026).

While viral suppression was reported to be high, respondents indicated that age-related testing, screening, and other geriatric care were significantly lacking. Just 17% of respondents reported being screened for HIV-related medical frailty, with screenings for frailty declining from 25% of patients under the age of 65 being screened in 2022 to just 11% in 2026. HealthHIV found that patients with lower incomes were significantly less likely to be screened at all.

PLWHA Are Heavily Burdened by Comorbid Non-HIV Chronic Conditions

More than 80% of respondents indicated that they have at least one non-HIV-related chronic condition for which they are currently taking prescription medications, of whom 22% reported having to change their antiretroviral (ARV) medication due to a contraindication with another drug.

HealthHIV’s analysis of responses found that more than 25% of respondents have very high medical needs, but are underserved.

Photo Source: HealthHIV

Behavioral and Mental Health Issues Are Prevalent Among Older PLWHA

More than 75% of respondents indicated having moderate or high levels of stress, but fewer than 2% of respondents identified mental health as being an immediate need. Many respondents indicated that they had a “good” quality of life, but also carried high levels of stress. HealthHIV suggests that this finding indicates that respondents place more importance on the outward appearance of wellness while simultaneously ignoring or disregarding mental health as a part of a “good” quality of life.

Research has found that high levels of psychological stress can have negative impacts on PLWHA and their physical health and health outcomes. For example, traumatic and stressful life experiences have been associated with reduced adherence to treatment regimens, virologic failure, higher rates of mortality and opportunistic infections, increases in the use of recreational drugs in such ways that may result in behaviors detrimental to the health of both the patient and others, and arterial inflammation (Reif et al., 2013; Chow et al., 2023).

Access to and Paying for Medications and Treatment is Likely to Get Tougher for PLWHA in the Future

While existing programs and insurance coverage of ARV treatments are currently working, HealthHIV reports that those systems, like PLWHA who are aging, are becoming increasingly frail.

HealthHIV highlights reports that state AIDS Drug Assistance Program (ADAP) budgets are becoming increasingly strained, and that the reintroduction of waiting lists (Hopkins, 2026) in Iowa and Utah presages tough times ahead for PLWHA who are aging.

Photo Source: HealthHIV

According to the survey, fewer than half of respondents had retirement plans (largely because many didn't expect to live into their 50s), almost one-third reported food insecurity, and one in five avoided care due to cost.

Respondents to HealthHIV’s survey reported that transportation remains the strongest single barrier to accessing care and treatment, with lower-income patients being six times more likely to miss an HIV appointment because they cannot get to the appointment. Additionally, HealthHIV reports that more than half of Medicare enrollees still rely on the Ryan White HIV/AIDS Program (RWHAP) and ADAP to access HIV medications.

Providers Are Largely Unequipped to Effectively Treat Aging PLWHA

Providers who responded to HealthHIV’s survey reported that, while they understand that aging PLWHA face unique needs that require specialized care, they currently lack the staff, funding, or expertise to provide these services.

HealthHIV found that just 1.2% of provider respondents specialized in gerontology, compared with 21% with specializations in HIV medicine. Moreover, they found that workforce turnover is eroding the institutional knowledge and awareness of both the history of the HIV epidemic and the cultural and lived experiences of aging PLWHA.

Photo Source: HealthHIV

Regarding aging-care readiness among patients, providers reported troubling trends. Among them, only half were aware of the protections afforded to them under the Americans with Disabilities Act (ADA), a fact that is particularly important for end-of-life planning. Fewer than one-fourth of providers offer advance care planning, which is compounded by the fact that only 16% of caregivers report having adequate support.

In Closing

HealthHIV has made available the final report for its fifth State of Aging with HIV™ survey on its website at healthhiv.org/stateof/agingwithhiv/. On May 6th, HealthHIV hosted an educational webinar, and free access to this on-demand webinar is available online, along with the presentation slides. 

At this point in history, more than half of PLWHA are over the age of 50, making this research essential to maintaining a robust and effective HIV care continuum. 

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

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

References:

[1] Centers for Disease Control & Prevention. (2026, March 16). Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection—Medical Monitoring Project, United States, 2023 Cycle (June 2023—May 2024). Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: HIV Data: Medical Monitoring Project. https://www.cdc.gov/hiv-data/mmp/behavioral-clinical-characteristics-pwh-2023.html

[2] Chow, F. C., Mundada, N. S., Abohashem, S., La Joie, R., Iaccarino, L., Arechiga, V. M., Swaminathan, S., Rabinovici, G. D., Epel, E. S., Tawakol, A., & Hsue, P. Y. (2023, October). Psychological stress is associated with arterial inflammation in people living with treated HIV infection. Brain, Behavior, and Immunity, 113, 21-28. https://doi.org/10.1016/j.bbi.2023.06.019

[3] HealthHIV. (2026). Findings and implications from HealthHIV State of Aging with HIV Fifth Annual Survey. Washington, DC: HealthHIV: State of. https://healthhiv.org/stateof/agingwithhiv/

[4] Hopkins, M. J. (2026, May 14). The ADAP “Perfect Storm” Returns; Over 1,000 Patients Being Denied Care. Nags Head, NC: ADAP Advocacy: Blog. https://adapadvocacyassociation.blogspot.com/2026/05/the-adap-perfect-storm-returns-over.html

[5] Reif, S., Mugavero, M., Raper, J., Theilman, N., Leserman, J., Whetten, K., & Pence, B. W. (2011, February). Highly Stressed: Stressful and Traumatic Experiences among individuals with HIV/AIDS in the Deep South. AIDS Care, 23(2), 152-162. https://doi.org/10.1080/09540121.2010.498872

The ADAP “Perfect Storm” Returns; Over 1,000 Patients Being Denied Care

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

What’s old is new, again! The “Perfect Storm” that confronted state AIDS Drug Assistance Programs for nearly a decade and resulted in patients living with HIV/AIDS being denied access to care is now the reality…again! 

According to the National Alliance of State and Territorial AIDS Directors (NASTAD), two states—Iowa and Utah—have implemented waiting lists for their ADAPs, becoming the first to do so in thirteen years. 1,106 patients living with HIV/AIDS are impacted in Iowa, and another 10 in Utah (NASTAD, 2026b).

Photo Source: NASTAD

The reimplementation of waiting lists comes after 12 years of flat funding for ADAP at the federal level and 2 decades of declining state-level funding (NASTAD, 2026a). These conditions have been exacerbated with the passage of the One Big Beautiful Bill, which decimated the social safety net (Segal, 2025). 

ADAP waiting lists were commonplace in the 2000s and into the mid-2010s, with waiting list rosters reaching their peak in 2011, with 9,298 Persons Living with HIV/AIDS (PLWHA) impacted across eleven states (The Henry J. Kaiser Family Foundation, 2017). In 2003, eight patients died while on ADAP waiting lists, including 5 in Kentucky and three in West Virginia (Connolly, 2004).

The reality is that ADAP programs quite literally save lives.

Research published in Clinical Infectious Diseases found that, despite ADAPs serving less than 25% PLWHA in the United States, ADAP clients account for almost a third of the entire viral suppression rate, with viral suppression rates ranging from 81.2% to 91.4% for ADAP client, compared with the overall viral suppression rate of 60% to 66.3% (McManus et al., 2026).

While Iowa and Utah are the first to reintroduce waiting lists, they are unlikely to be the last, particularly given the Trump Administration’s proposed budget, which has been characterized as having an open disdain for federal healthcare and social assistance programs.

Photo Source: Rolling Stone

In April 2026, the White House’s Fiscal Year 2027 Budget proposal calls for the wholesale elimination of the Housing Opportunities for Persons With HIV/AIDS (HOPWA) program, referring to the program as “…outdated by focusing on housing low-income, homeless, and at-risk HIV-positive individuals, as the prognosis and medical care for HIV have significantly improved since the 1990s” (Office of Management and Budget, 2026).

In addition to waiting lists, NASTAD’s April 2026 ADAP Watch also reported that 19 programs are facing budget deficits, citing the following reasons:

• Increasing drug costs/expenditures per client
• Increasing health insurance premium costs
• The expiration of enhanced premium tax credits
• Increasing client enrollment
• Decreasing 340B drug pricing program rebate revenues, and
• Changes in federal allocations or supplemental funding (NASTAD, 2026b)

Two states—Indiana and Utah—have also introduced ADAP enrollment caps, with Indiana capping enrollment at 4,500 patients and Utah at 225 full-pay clients in addition to the aforementioned waiting lists. The travesty happening to Floridians living with HIV/AIDS is an entirely different situation, with one HIV advocate calling it “an open season on people living with AIDS,” and another to pen her pre-obituary as a "protest" as that state attempts to kick thousands of patients off its ADAP services.

Photo Source: ADAP Advocacy

Additional cost-containment measures, including the previously reported lowering of income eligibility thresholds across various states (Hopkins, 2026), are likely to be implemented in the coming year, with little end in sight unless federal and state legislators decide to reprioritize PLWHA.

ADAP Advocacy will continue to monitor and report on changes to ADAP waiting lists as new developments occur, as it is taking steps to launch a national advocacy campaign to confront them.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

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

References:

[1] Connolly, C. (2004, May 20). States Offering Less Assistance For AIDS Drugs Federal Spending Is Up, but So Is Demand, Survey Finds. The Washington Post. https://www.washingtonpost.com/wp-dyn/articles/A41229-2004May19.html 

[2] Henry J. Kaiser Family Foundation, The (2017, August). AIDS Drug Assistance Programs (ADAPs). Menlo Park, CA: The Henry J. Kaiser Family Foundation: Fact Sheet. https://files.kff.org/attachment/Fact-Sheet-AIDS-Drug-Assistance-Programs

[3] Hopkins, M. J. (2026, March 26). Ryan White Programmatic Funding Balances on a Precarious Precipice. Nags Head, NC: ADAP Advocacy: Blog. https://adapadvocacyassociation.blogspot.com/2026/03/ryan-white-programmatic-funding.html

[4] McManus, K. A., Killelea, A., Rogers, E. Q., Liu, F., Horn, T., Steen, A., Keim-Malpass, J., Hamp, A., & Rogawski McQuade, E. T. (2026, March 25). State AIDS Drug Assistance Programs’ Contribution to the US Viral Suppression, 2015–2022. Clinical Infectious Diseases, ciag034. https://doi.org/10.1093/cid/ciag034

[5] National Alliance of State and Territorial AIDS Directors. (2026a). 2026 National Ryan White HIV/AIDS Program Part B ADAP Monitoring Project Annual Report: Stabilizing the Safety Net: Stewardship and Outcomes in a Volatile Landscape. Washington, DC: National Alliance of State and Territorial AIDS Directors. https://nastad.org/2026-rwhap-part-b-adap-monitoring-report

[6] National Alliance of State and Territorial AIDS Directors. (2026b, April). ADAP Watch: April 2026. Washington, DC: National Alliance of State and Territorial AIDS Directors: Resources: ADAP Watch. https://nastad.org/sites/default/files/2026-04/adap-watch-april-2026.pdf

[7] Office of Management and Budget. (2026). Budget of the U.S. Government. Washington, DC: Executive Office of the President: Office of Management and Budget. https://www.whitehouse.gov/wp-content/uploads/2026/04/budget_fy2027.pdf

[8] Segal, B. (2025, July 3). How the ‘One Big, Beautiful Bill’ Targets Medicare and Medicaid. GovFact.org. https://govfacts.org/money/social-safety-net/medicare-medicaid/how-the-one-big-beautiful-bill-targets-medicare-and-medicaid/

Treatment of HIV with ART Slows Advanced Biological Aging Process

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Research presented at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global conference in Munich, Germany, has found that early initiation of antiretroviral therapy (ART) for HIV reduces accelerated aging in people living with the virus (Ryan et al., 2026).

Photo Source: ESCMID

While this research is currently in pre-print form, meaning that it has not been peer reviewed for final publication, it could help to provide additional ammunition in the argument that initiating ART as soon as possible can help People Living with HIV/AIDS (PLWHA) live longer, healthier lives.

Researchers developed a plasma proteomic aging clock (PAC)—a tool used to estimate biological age, measuring the age of the body, as opposed to chronological age which measures a body’s age in terms of birth year to present. During the period prior to initiating ART, the PAC estimated that participants’ biological age was accelerated by a median of 10 years. With effective ART, this was reduced by nearly four years. 

How Does HIV Cause Accelerated Aging?

Research has suggested that, soon after the acquisition of HIV, the virus causes the human body to begin an accelerated aging process at the DNA level, contributing to the earlier onset of age-related diseases, such as heart and kidney diseases, medical and physical frailty, and cognitive difficulties (Rivero, 2022). Research published in 2022 found that this accelerated aging process begins within three years of the initial acquisition (Breen et al., 2022).

Earlier research also found that PLWHA may experience lipodystrophy—abnormal fat distribution—in both treated and untreated HIV, which can include the loss of subcutaneous fat in the face, extremities, and buttocks, as well as an increase in fat in the abdominal area, breasts, or at the top of the back, known as “buffalo hump.” This research also found that a combination of metabolic and immunologic changes can cause or exacerbate cardiovascular disease in PLWHA (Meir-Shafrir & Pollack, 2012).

Photo Source: MEDXY

What Does This Mean for People Living with HIV/AIDS?

Prior to 2012, people who had been diagnosed with HIV were not advised to begin ART until they had received an AIDS diagnosis after their CD4 (T-cell) count had fallen below 200 per microliter of blood (Castro et al., 1992). In March 2012, the Centers for Disease Control and Prevention (CDC) updated its treatment recommendations to recommend beginning ART as soon as possible, rather than waiting for an AIDS diagnosis (CDC, 2012).

This change has led to an overall decrease in the number of new diagnoses, in no small part due to the fact that PLWHA who are receiving ART and are virally suppressed have been shown to be unable to transmit the virus through sexual contact (CDC, 2024).

For PLWHA, early initiation of ART can help to slow down the accelerated aging process. This is true, also, for those currently receiving ART, which makes remaining on treatment and being virally suppressed even more important.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

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

References:

[1] Breen, E. C., Sehl, M. E., Shih, R., Langfelder, P., Wang, R., Horvath, S., Bream, J. H., Duggal, P., Martinson, J., Wolinsky, S. M., Martinez-Maza, O., Ramirez, C. M., & Jamieson, B. D. (2022, July 15). Accelerated aging with HIV occurs at the time of initial HIV infection. iScience, 25(7), 104488. https://doi.org/10.5041/RMMJ.10089

[2] Castro, K. G., Ward, J. W., Slutsker, L., Buehler, J. W., Jaffe, H. W., Berkelman, R. L., & Curran, J. W. (1992, December 18). 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR, 41(RR-17). https://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm

[3] Centers for Disease Control and Prevention. (2012). Changes in US HIV Treatment Guidelines [Transcript]. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: Audio Rounds. https://tools.cdc.gov/podcasts/media/pdf/AudioRounds_HIV_Tx_Guidleines.pdf

[4] Centers for Disease Control and Prevention. (2024, October 24). HIV Treatment as Prevention. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: HIV Public Health Partners: HIV Treatment. https://www.cdc.gov/hivpartners/php/hiv-treatment/index.html

[5] Meir-Shafrir, K. & Pollack, S. (2012, October). Accelerated Aging in HIV Patients. Rambam Maimonides Medical Journal, 3(4), e0025. https://doi.org/10.5041/RMMJ.1008

[6] Rivero, E. (2022, June 30). Study shows HIV speeds up body’s aging processes soon after infection. Los Angeles, CA: University of California Los Angeles: UCLA Health: News: Release. https://www.uclahealth.org/news/release/study-shows-hiv-speeds-up-bodys-aging-processes-soon-after

[7] Ryan, B., Oumelloul, M. A., Rouached, S., Juillerat, A. D., Giacccheto, L., Thorball, C. W., Schoepf, I. C., Arribas, J. R., Soldevila, B. R., Kootstra, N., Reiss, P., Jackson-Perry, D., Haerry, D. H-U., Günthard, H. F., Bartl, L., Dollé, C., Russenberger, D., Nanni, P., Kockmann, T., … Tarr, P. E. (2026, March 26). A Plasma Proteomic Ageing Clock Reflects Advanced Ageing in People with Untreated HIV and its Reduction Under Antiretroviral Therapy. medRxiv. https://doi.org/10.64898/2026.03.24.26348875