What’s Affordable, Anyway?

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

New polling data from the Kaiser Family Foundation (KFF) found that the cost of living—particularly healthcare and gasoline costs—is at the top of Americans’ minds as the U.S. heads into the 2026 mid-term elections. KFF found that, when asked if they were worried about being able to afford different basic needs, 60% of respondents indicated that healthcare costs, including the costs of health insurance and out-of-pocket expenses, such as office visits and prescription drugs, were of most concern, followed by 59% of respondents indicating that gasoline and transportation costs were top of mind (Schumacher et al., 2026).

Source: Gallup

This raises a key question with which few are willing to grapple:

How are we defining “affordable”?

In the strictest sense, “affordable” means something is priced low enough to be easily paid for or purchased.

But this raises another important question:

Affordable for whom?

According to Donald J. Trump, “The word ‘affordability’ is a Democrat scam” (Revell, 2025). He’s also called the concept of affordability a “fake narrative,” a “hoax,” and a “con job” (Green, 2025).

None of this is surprising, as the president has never had to “afford” anything in his entire life; nor, apparently, have any key members of his administration, including Trump Secretary of the Treasury, Scott Bessent, who claimed that Americans should be worried about affordability because, “…the Biden Administration destroyed affordability” (Wang & Farrow, 2026).

This has been the refrain of Republicans at both the state and federal levels since time immemorial: when costs increase during a Republican administration, it is always the fault of Democratic policies and politicians, regardless of how long Republicans have been in power and irrespective of objective reality.

But let us not lay the blame of unaffordability directly at the feet of just Republicans. Democrats have regularly abused the word “affordable,” with the naming of the Affordable Care Act (ACA) serving as one of the primary examples of how simply slapping the word “affordable” on something does not make it affordable. Despite its promises to control healthcare cost growth, national healthcare expenditures (in 2024 U.S. dollars) have soared from $3.83 trillion in 2014, when much of the ACA took effect, to $5.28 trillion in 2024 (Rakshit et al., 2026).

The issue with affordability is that it is largely subjective: when you’re poor, virtually nothing is “affordable” unless it’s free; when you’re wealthy and don’t have to worry about choosing food or healthcare, your concept of affordability skews toward your own experiences.

And maybe this is the crux of the issue: the people who set the policies that affect prices—from filing fees to taxes to tariffs to rates for goods and services—live in a bubble where “affordability” is largely an afterthought.

Source: Institute for New Economic Thinking

Despite consistent promises made by every presidential administration since the 1970s’ stagflation crisis to make life more affordable for Americans, nothing seems to change, in no small part because the private entities that set prices for food, healthcare services, and medications are often the largest donors to American politicians. When it comes time to craft meaningful legislative and administrative solutions to actually make life affordable, those donors expect obeisance from the officials they’ve purchased.

When it comes to healthcare costs, the same truths come into sharper focus. Few other industries are so regularly and publicly asked to substantiate the costs of their services to the American public—or Congress—than actors in the healthcare space. Health insurers, pharmaceutical manufacturers, and hospital industry representatives are often required to show up and justify why costs are so high, but little decisive action to reduce costs for consumers is ever taken; instead, we get political theater, even when both political teams come out swinging against the healthcare industry, and no real changes.

Why is that?

The simplest explanation is that nobody wants to truly upset the two proverbial apple carts:

The first apple cart holds the industries that provide healthcare services to Americans. In 2024, healthcare expenditures in the U.S. accounted for 18% of economic spending as a percentage of Gross Domestic Product (GDP), and that number is expected to grow to 21% by 2034 (Peter G. Peterson Foundation, 2026). Moreover, the U.S. healthcare system depends heavily on various funding mechanisms, such as the 340B Drug Pricing Program, for survival, meaning that trying to solve the healthcare affordability crisis by addressing just one aspect of healthcare services could cause another to collapse.

For example, 340B-eligible hospitals argue that if they are forced to demonstrate they are using 340B revenues appropriately, they will have to close locations. Why? Because that level of transparency would cost them their eligibility.

But this isn’t just the argument made by hospitals. Virtually any policy that is designed to lower costs for consumers is met with thinly veiled threats by healthcare industry players:

The most common refrain we hear from pharmaceutical partners is that any price controls introduced in the U.S. will force them to slow innovation, slow or halt drug development, or simply take products off the market. Health insurers echo this refrain, arguing that any attempt to force them to lower premiums and deductibles will force them to close operations and leave people without health insurance coverage.

This makes the first apple cart particularly pernicious: healthcare industries are more than willing to threaten service reductions or closures when their profits are threatened.

The second apple cart holds the donors that can make or break political campaigns.

Source: Politico

It’s hard to demand substantive changes from those who have paid their way into office, or who have used their position to enhance their personal wealth. When industries are allowed to bankroll politicians—actions that have been deemed “protected speech” by the U.S. Supreme Court—it’s not surprising that they then expect those politicians to fall in line when it comes to advancing their interests over the interests of everyday Americans. As a result, we get regulatory frameworks without teeth; healthcare laws that don’t actually control healthcare costs; endless Congressional investigations and hearings that provide excellent soundbites, but don’t go anywhere in terms of legislation and policymaking.

The hard truth for many to swallow is that making healthcare affordable means making it affordable for everyone, whether healthcare industry players like it or not. This means regulations and eligibility requirements that have teeth; it means making it more expensive for companies to fall out of compliance than to comply; it means revoking eligibility for federal programs, subsidies, and pricing agreements if providers are regularly non-compliant.

But this is not a conversation that many are willing to have, because in America, the Almighty Dollar is King. And so long as profits are high and shareholders are happy, we plebeians can go kick rocks!

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] Green, E. L. (2025, December 02). Trump Calls Affordability a ‘Con Job’ as His Edge on the Economy Slips. New York, NY: The New York Times: US: Politics. https://www.nytimes.com/2025/12/02/us/politics/trump-affordability-economy-messaging.html

[2] Peter G. Peterson Foundation. (2026, August 11). Chart Pack: Healthcare. New York, NY: Peter G. Peterson Foundation. https://www.pgpf.org/article/chart-pack-healthcare/

[3] Rakshit, S., Winger, A., Cotter, L., McGough, M., Wager, E., & Cox, C. (2026, January 22). How has U.S. spending on healthcare changed over time? San Francisco, CA: Peterson-KFF Health System Tracker: Health Spending. https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/

[4] Revell, E. (2025, December 02). Trump calls affordability 'a Democrat scam' as inflation concerns persist nationwide. New York, NY: Fox Business: Politics. https://www.foxbusiness.com/politics/trump-calls-affordability-a-democrat-scam-inflation-concerns-persist-nationwide

[5] Schumacher, S., Valdes, I., Mulugeta, M., Kearney, A., Kirzinger, A., & Hamel, L. (2026, October 06). KFF Health Tracking Poll: Health Care Issues in the Lead-Up to the 2026 Midterm Election. San Francisco, CA: KFF: Public Opinion. https://www.kff.org/public-opinion/kff-health-tracking-poll-health-care-issues-in-the-lead-up-to-the-2026-midterm-election/

[6] Wang, S. & Farrow, F. (2026, January 28). Bessent says Americans 'should be worried about affordability,' but blames Biden for cost issues. New York, NY: ABC News: Politics. https://abcnews.com/Politics/bessent-americans-worried-affordability-blames-biden-cost-issues/story?id=129636939

340B: The Glue That Should Hold Our Healthcare System Together

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

In June 2026, ADAP Advocacy released its latest policy paper—340B Program: The Glue That Should Hold Our Healthcare System Together—focusing on the explosive growth of the 340B Program from just 1,000 covered entities (CEs) and 503 contract pharmacies (CPs) in 1992 to over 53,000 CEs and 34,840 CPs in 2024. In addition to examining this growth and its causes, ADAP Advocacy also provided concrete recommendations to ensure the 340B Program can function in perpetuity (Macsata, et al., 2026). The policy paper is the latest in a series supporting the organization's argument that the 340B Program is too big to fail.

Source: ADAP Advocacy

ADAP Advocacy argues that, because the 340B Program spans more than 42,000 healthcare organizations and 32,000 pharmacies, it should be the glue that holds our healthcare system together. Instead, the 340B program has essentially become a slush fund for unscrupulous CEs—primarily hospitals—that lines executives’ pockets while cutting corners, costs, and services for both staff and patients. That’s not to suggest the program isn’t vitally important, or that there aren’t plenty of good actors…CEs…in the 340B space, because it is, and there are. The fact of the matter is a healthcare program of this size and magnitude cannot be entrusted to good faith alone; rather, improved transparency guardrails are needed to ensure its success and ultimately its intended beneficiaries: patients.

Primary Drivers of Growth:

ADAP Advocacy identified several key drivers of growth in the 340B program, including:

• The expansion of eligibility categories;
• The expansion of large health systems;
• The growing utilization by CEs of off-site clinics and child sites; and
• The explosive growth of Pharmacy Benefit Managers (PBMs) and contract pharmacies operating in the American healthcare space as third-party administrators for CEs

Policy Proposals

ADAP Advocacy also recommended several policy proposals to address the myriad issues facing the program, including:

• The implementation of a program-wide rebate model, in which drugs are purchased at full price up front, and rebates are provided by manufacturers at a later date;
• The consideration of a rebate “sales draw” under the program-wide rebate model that accounts for agencies with smaller annual operating revenues (e.g., those with less than $2 million);
• Mandatory reporting requirements for CEs, including how revenues have been used to improve patient care, reduce drug costs, or expand community services;
• Clearly defining “patient” in the statute—who qualifies as a patient, and which purchases qualify for 340B rebates; and
• Establishing an enforcement mechanism with real teeth and penalties ranging from civil monetary penalties to loss of 340B eligibility.

Each proposal is designed to ensure 340B revenues are used for patients in need, as intended by those who created the program. And these changes are long overdue.

Source: ADAP Advocacy | iStock

In 2025, 340B drugs exceeded $179.5 billion in list prices, with hospitals as the biggest cost driver (Martin et al, 2026). The 340B Program is immensely significant, and rising waste, fraud, and abuse pose an increasing risk. Because the American healthcare system is highly interdependent, a weakness in one sector can have widespread repercussions, making the 340B Program's impact especially important. 

Research published in September 2026 by the Pioneer Institute found that hospitals participating in the 340B Program spent an average of just 2.16% of their operating expenses on charity care, compared to 2.82% at non-340B hospitals. It also found that 340B hospitals spent just 1.6% of operating expenses on care for uninsured patients, compared with 2.26% at non-340B hospitals (Popovian et al., 2026).

Popovian et al. are quick to point out that their findings do not suggest that participating in the 340B Program “causes” hospitals to provide less charity care or care at cost; rather, their findings demonstrate that the 340B Program’s drug discounts, savings, and revenues do not reliably translate into providing more help for patients (either in terms of healthcare provision or lower costs), and that current reporting requirements are insufficient to ensure that 340B revenues are being appropriately utilized in ways that comport with either the letter or intent of the statute.

Source: Pioneer Health

Last month, ADAP Advocacy launched a national advocacy campaign focused on the data and findings of its most recent 340B white paper, including infographics, social media posts, op-eds, and video content. The campaign is patient-centric in that it informs patients, regardless of their chronic health condition or rare disease, why they can no longer sit on the sidelines and watch the pharmaceutical industry and big hospital systems duke it out over what is in our best interest. Nothing about us, without us!

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] Macsata, B. M., Anthony, G., Hopkins, M. J., Sosa, J. (2026, June). 340B Program: The Glue That Should Hold Our Healthcare System Together. Nags Head, NC: ADAP Advocacy: Policy Center: 340B: Policy Papers. https://www.adapadvocacy.org/s/2026_ADAP_Project_RW_340B_Asset_32_340B_Glue_Should_Hold_Healthcare_Together_061526.pdf

[2] Martin, R., Karne, H., Zen, S. (2026, June), The Size and Growth of the 340B Program in 2025. IQVIA. https://www.iqvia.com/-/media/iqvia/pdfs/us/white-paper/2026/iqvia-size--growth-of-340b-in-2025-white-paper-2026.pdf

[3] Popovian, R., Sydor, A. M., Czubaruk, K., Walker, M., & Smith, W. (2026, September 24). The 340B Accountability Gap: Charity Care, Uncompensated Care, and Medicaid Patient Volume Among 340B and Non-340B Hospitals: What the Data Mean for 340B Accountability and Reform. Boston, MA: The Pioneer Institute: Pioneer Health. https://pioneerinstitute.org/wp-content/uploads/2026/09/2026-09-08-Cancer-Care-340B-Paper.pdf

CDC Releases New Information About People Living With HIV/AIDS

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

The Centers for Disease Control and Prevention (CDC) released its latest update to the Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection in September 2026. These data represent findings from people living with HIV/AIDS (PLWHA) collected in 2024, and could point to significant trouble ahead for PLWHA (CDC, 2026).

Source: CDC

Key Findings and Discussion:

While 80% of respondents were prescribed antiretroviral therapy (ART) to treat their HIV, only 63% reported taking every dose as prescribed. Among those who missed doses, 22.7% missed doses for 1 to 2 days, 10.2% for 3 to 5 days, 1.5% for 6 to 10 days, and 2.3% for 11 or more days. The most commonly reported reasons for not taking medications included:

• Forgetting to take them (69.1%)
• Changes in daily routines or travel (42.3%)
• Falling asleep early or oversleeping (38.4%)
• Feeling depressed or overwhelmed (21%)
• Problems getting prescriptions or refilling medications (18.5%)
• The person didn’t feel like taking them (14.1%)
• Alcohol or drug use (10.3%)
• Problems paying for medications (6.9%)
• In the hospital or too sick to take medications (6.6%)
• Difficulties with medication side effects (5.8%)

When disaggregated by sex, Female respondents were slightly more likely to be adherent to treatment (66.2%), while 62.5% of Males reported being adherent.

When disaggregated by race, Multiracial Americans were the least likely to be treatment adherent (59.5%), followed by Black Americans (62%), Hispanic/Latine Americans (63.1%), and White Americans (65.6%). Asian Americans had the highest rate of treatment adherence, at 70.6%.

When disaggregated by age, adults aged 50+ were most likely to be treatment adherent (69.9%), followed by those aged 40-49 (58.3%) and those aged 18-29 (53.6%). Adults aged 30-39 were the least adherent, at 50.6%.

These data are particularly problematic, as failure to adhere to treatment regimens can result in the mutation of the virus to become resistant to specific ARTs or drug classes, making HIV harder to treat and limiting future treatment options. Additionally, nonadherence to ART regimens can leave the virus unsuppressed, increasing the likelihood of transmitting it to others (HIV dot Gov, 2026).

Source: Marley Drug

How to Improve Treatment Adherence

The HIV treatment landscape has changed significantly over the past twenty years. While treating HIV once required patients to take and keep track of multiple pills a day (or daily injections), single-pill oral regimens became the norm in the 2010s, and now, we have long-acting injectable (LAI) medications that can be delivered monthly or every other month.

A recent study published in The New England Journal of Medicine found that patients treated with LAIs were significantly less likely to experience regimen failure (n = 29; 19%) than patients taking a standard oral regimen (n = 55; 36%). While most regimen failures in the standard group resulted from virologic failure (58.2%), treatment discontinuation or abandonment caused regimen failure in the LAI group (82.6%). At the 48-week mark, regimen failure was 22.8% in the LAI group and 41.2% in the standard oral regimen group, indicating that LAIs are a key component to improve treatment adherence and virologic suppression (Rana et al., 2026)

ADAP Advocacy’s own research found that 52.3% of patients who responded to a 2024 survey would prefer LAI treatment regimens over oral regimens (Johnson et al., 2024).

Source: ADAP Advocacy

Quality of Life and HIV

Additional findings of the MMP found that structural challenges continue to negatively impact PLWHA, with respondents reporting hunger or food insecurity (22%), unstable housing or homelessness (20%), and unemployment (15%) as being primary drivers of poor physical, mental, and emotional health. Moreover, many PLWHA reported unmet needs for ancillary services that could improve living conditions and well-being, including access to dental care (24%), meal or food service assistance (15%), and stable sheltering or housing services (15%).

Trouble Ahead

The real concern in these data is not the data themselves, but that they were gathered before the Trump Administration took wrecking balls to nearly every aspect of public health provision and services. With state ADAP programs facing increasing budgetary shortfalls that could result in constriction of state programs (Hopkins, 2026), the forthcoming Medicaid implosion that the Trump Administration and its allies in Congress forced through in the One Big Beautiful Bill Act (Hopkins, 2025), and exploding costs of living related to the ongoing war against Iran and nonsensical tariffs, including skyrocketing costs of fuel, diesel, food, goods, and services (Wile & Murphy, 2026; Zahn, 2026), PLWHA are going to be squeezed more than ever. The reality is that patients living with HIV are going to be significantly worse off financially and are likely to face significantly higher barriers to accessing not only HIV care and treatment, but basic necessities, like food, shelter, and transportation.

While we should have been preparing for this for a while, many of us were caught flat-footed by the wholesale destruction being wrought by the Trump Administration. Hopefully, we will be able to course correct enough to avoid the majority of the devastation many are predicting.

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 and Prevention. (2026, September 10). Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention: Division of HIV Prevention: HIV Data: Medical Monitoring Project. https://www.cdc.gov/hiv-data/mmp/behavioral-clinical-characteristics-pwh.html

[2] HIV dot Gov. (2026, September 24). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Rockville, MD: United States Department of Health and Human Services: Office of Infectious Disease and HIV/AIDS Policy: HIV dot Gov: Clinical Info: Guidelines. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/interruption-antiretroviral-therapy

[3] Hopkins, M. J. (2025, July 30). Preparing for One Big Beautiful Disaster. Washington, DC: PlusInc: Blog. https://www.plusinc.org/blog/one-big-beautiful-disaster

[4] Hopkins, M. J. (2026, September 24). ADAP: A House of Cards Waiting to Fall. Nags Head, NC: ADAP Advocacy: ADAP Blog. https://adapadvocacyassociation.blogspot.com/2026/09/a-house-of-cards-waiting-to-fall.html

[5] Johnson, R. D., Hopkins, M. J., Laws, J., & Macsata, B. M. (2024). HIV Long-Acting Injectables: Patient access considerations for injectable HIV therapies and injectable HIV Pre-Exposure Prophylaxis. Nags Head, NC: ADAP Advocacy. https://www.adapadvocacy.org/s/2024_ADAP_Project_Long_Acting_Injectables_Final_Report_062524-wgxy.pdf

[6] Rana, A. I., Zheng, L., Castillo-Mancilla, J., Bao, Y., Sieczkarski, S., Brooks, K. M., Lake, J. E., Fichtenbaum, C., Heath, S. L., Belaunzaran-Zamudio, P. F., Klingman, K., Fox, L., Morton, T., Stirratt, M., Li, J. Z., Acosta, E. P., Venuto, C., Galárraga, O., Shoptaw, S., Wohl, D., … ACTG A5359 LATITUDE Trial Team. (2026). Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges. The New England journal of medicine, 394(9), 858–871. https://doi.org/10.1056/NEJMoa2508228

[7] Wile, R. & Murphy, J. (2026, September 23). The U.S. economy before and after the Iran war, in five charts. New York, NY: NBC News: Business: Economy. https://www.nbcnews.com/business/economy/us-economy-iran-war-five-charts-rcna598412

[8] Zahn, M. (2026, August 25). Tariffs will cost US households over $1,000 a year, Yale Budget Lab says. Burbank, CA: ABC: ABC News: Business. https://abcnews.com/Business/tariffs-cost-us-households-1000-year-yale-budget/story?id=135945432

ADAP: A House of Cards Waiting to Fall

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

Did you know that Federal funding for the AIDS Drug Assistance Program (ADAP) accounted for just 29% of the 2024 national ADAP budget? Did you know that Congress has not appropriated any new money for the ADAP budget in over a decade?

It’s true!

Source: KFF

According to the National Alliance of State and Territorial AIDS Directors (NASTAD), federal appropriations for ADAP account for a vanishingly small percentage of the national ADAP budget (NASTAD, 2026).

Since the establishment of the Ryan White HIV/AIDS Program in 1990, Congress has appropriated funds specifically to address the provision of medications to treat HIV/AIDS for patients who might otherwise be unable to afford them. But the spending power of those federal dollars has fallen significantly over the past twenty years.

In Fiscal Year 2004, federal appropriations accounted for 61%, state-level funding for 19%, and drug rebates for 12%.

Fast forward to 2024—the most recent year for which data are available—and that funding model is fundamentally different:

In FY2024, drug rebates accounted for 52%, federal funding for 29%, and state-level funding for just 4%.

According to a presentation delivered by NASTAD’s Tim Horn at ADAP Advocacy’s recent Health Fireside Chat in Pittsburgh, Pennsylvania, federal funding for the AIDS Drug Assistance Program has been stalled at ~$900 million annually for a program that costs $2.7 billion (Macsata & Hopkins, 2026).

And now, yet another crisis has landed itself in ADAP's proverbial lap. After 13 years, people living with HIV/AIDS in two states are once again being denied access to care and treatment because ADAP is running out of money. According to NASTAD’s ADAP Watch, Iowa and Utah have ADAP waiting lists.

Source: NASTAD

How did we get here?

Put plainly, ADAP has been largely forgotten by federal and state legislators, in much the same way that many people seem to have forgotten that HIV/AIDS still exists. Unless someone is in front of them banging the drum that people are still being diagnosed and living with HIV/AIDS, it’s out of sight, out of mind.

In many ways, the reluctance of HIV advocacy organizations to actively and vocally push for increases to the ADAP earmark comes from a place of fear: fear that, by reminding legislators that HIV/AIDS exists, it places HIV funding at risk of further funding cuts.

And that fear isn’t without merit; since resuming office in January 2025, Donald Trump’s administration has actively worked to dismantle and defund HIV services at home and abroad.

In 2025, the Trump Administration:

• Issued a stop-work order that froze all programming and services for the President’s Emergency Plan for AIDS Relief (PEPFAR), which halted all work in the field, including the provision of antiretroviral therapy (ART);
• Issued a limited waiver for PEPFAR that allowed only ‘life-saving HIV services,” which excluded most HIV prevention services;
• Dissolved the USAID program that administered the PEPFAR program;
• Canceled funding for hundreds of programs that included HIV activities (KFF, 2026)

Source: STAT | Getty Images

Beyond pulling the rug out from under PEPFAR, the Trump Administration has gone further by announcing it will not renew $46 million in funding for Community-Based Organizations (CBOs) to provide HIV testing, linkage to care, referrals to pre- and post-exposure drug treatment, and outbreak response (Cohen, 2026). Instead, those funds will be redirected to state and local health departments—an effort to control how the funds are used and who they reach, avoiding funding for “Diversity, Equity, and Inclusion.”

The President’s 2027 budget also proposed eliminating $800 million from the Centers for Disease Control and Prevention’s HIV prevention funding (Cohen, 2026). Additionally, it proposed the elimination of the Housing Opportunities for People with AIDS (HOPWA) program—which serves over 100,000 households annually (Bennett & Hannon, n.d.).

In context, those cuts, whether they’re actual or proposed, paint an even bleaker picture of the state of ADAPs at the federal level. Even though more clients are enrolling and healthcare costs are climbing, federal funding for ADAPs hasn't really grown over the past decade. This means ADAPs have the same purchasing power as they did in 1999, once inflation is accounted for. HIV advocacy needs to remind Congress of the inherent value of this program.

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] Bennett, R. & Hannon, B. (n.d.) Housing Opportunities for Persons with AIDS (HOPWA). National Low Income Housing Coalition. https://nlihc.org/sites/default/files/AG-2025/4-135_Housing-Opportunities-for-Persons-with-Aids-HOPWA.pdf

[2] Cohen, A. (2026, July 20). Trump administration puts kibosh on HIV prevention funding. Washington, DC: Roll Call: Policy. https://rollcall.com/2026/07/20/trump-administration-puts-kibosh-on-hiv-prevention-funding/

[3] KFF. (2026, August 06). The Trump Administration’s Foreign Aid Review: Status of PEPFAR. San Francisco, CA: KFF: Global Health Policy. https://www.kff.org/global-health-policy/the-trump-administrations-foreign-aid-review-status-of-pepfar/

[4] Macsata, B. M. & Hopkins, M. J. (2026, August 20). Fireside Chat Retreat in Pittsburgh, PA Tackles Emerging Crisis Facing AIDS Drug Assistance Programs. Washington, DC: ADAP Advocacy: ADAP Blog. https://adapadvocacyassociation.blogspot.com/2026/08/fireside-chat-retreat-in-pittsburgh-pa.html

[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

Goliath vs. Goliath—How the 340B Devil’s Bargain Might Self-Destruct

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

Mount Sinai Health Systems (New York, NY), the University of Kansas Hospital Authority (Kansas City, KS), and the University of Michigan Hospitals and Health Centers (Ann Arbor, MI) are suing CVS Health for failing to properly reimburse them for drugs purchased and dispensed under the massive 340B Drug Pricing Program, claiming under-reimbursement to the tune of nearly $250 million over a period of five years (Hut, 2026).

Source: Forbes | Getty

The suits, filed in three separate courts, argue that CVS, which serves as a contract pharmacy for all three health systems, accuses CVS Health and its subsidiaries of retaining illegally large shares of 340B revenues generated and failing to remit them to the covered entities that generated the sales. The plaintiffs are seeking triple damages under the federal Racketeer Influenced and Corrupt Organizations (RICO) Act and seek injunctions enjoining CVS from continuing the business practices in question (Halleman, 2026).

In addition to the three initial suits, Henry Ford Health (Detroit, MI) sued CVS on July 16, alleging 340B revenue diversions amounting to more than $29 million, requesting the courts force CVS to disgorge any profits retained from the alleged diversion scheme and reinstate the pharmacy services CVS terminated with the health system in April—a termination that Henry Ford argues was in retaliation for its attempt to audit their arrangement with CVS (Jeffries, 2026a).

Source: Henry Ford Health

And then, a fifth hospital, Froedtert Memorial Lutheran Hospital (Milwaukee, WI), sued CVS Health on August 20th, alleging diversions amounting to $18 million between 2020 and 2025. When Froedtert attempted to audit CVS on March 2nd, 2026, CVS refused the request and terminated the hospital’s pharmacy services. This suit alleges breach of contract, fraud, violations of the Wisconsin Deceptive Trade Practice Act, and civil RICO violations, and it also seeks triple damages, reinstatement of the pharmacy services agreement, and disgorgement of profits derived from the scheme (Jeffries, 2026b).

CVS Health has been in the spotlight in 2026, after a particularly damaging congressional hearing in which Representative Alexandria Ocasio-Cortez (D-NY-14) all but accused CVS Health CEO David Joyner of operating an illegal monopoly.

During the January 22nd, 2026, hearing, Ocasio-Cortez highlighted what former CVS Health CEO Karen Lynch referred to as its “captive strategy,” in which CVS provides services to patients through its health insurance company, Aetna, and its primary care clinic, Oak Street Health, fills prescriptions through CVS, operates a Pharmacy Benefit Manager (PBM), CVS Caremark, and develops biosimilar medications through its Dublin, Ireland-based drug manufacturer, Cordavis (Hopkins, 2026).

Source: Rep. Alexandria Ocasio-Cortez

In response, CEO David Joyner stated, “No, I wouldn't agree that it's market concentration. I would suggest it's a model that works really well for the consumer.”

These suits against CVS Health bring to the fore one of the primary complaints against PBMs and contract pharmacy arrangements: if CVS (or any contract pharmacy or PBM) is surreptitiously or illegally hoarding 340B revenues, those are funds not being used to benefit patients. Maybe an amicus brief might be in order here?

To be certain, ADAP Advocacy has consistently called out many hospital systems for failing to properly use 340B revenues to benefit patients. In this case, five large health systems are going up against an equally large, and arguably more publicly bruised, company.

And we’re anxiously awaiting the outcomes...

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] Halleman, S. (2026, May 22). Hospitals sue CVS for allegedly siphoning $250M in 340B funds. Newton, MA: Healthcare Dive. News. https://www.healthcaredive.com/news/hospitals-file-340b-lawsuit-cvs-health/820959/

[2] Hopkins, M. J. (2026, January 29). Congress Shines Spotlight on Health Insurance Companies' Squeeze on Patients. Washington, DC: ADAP Advocacy: ADAP Blog. https://adapadvocacyassociation.blogspot.com/2026/01/congress-shines-spotlight-on-health.html

[3] Hut, N. (2026, May 27). 340B lawsuits against CVS allege $250M in underpaid hospital reimbursement. Downers Grove, IL: Healthcare Financial Management Association. https://www.hfma.org/payment-reimbursement-and-managed-care/cvs-340b-lawsuits-hospital-reimbursement/

[4] Jeffires, E. (2026a, July 22). Henry Ford Health sues CVS, alleges 340B pricing scheme. Chicago, IL: Becker’s Hospital Review: Legal & Regulatory Issues. https://www.beckershospitalreview.com/legal-regulatory-issues/henry-ford-health-sues-cvs-alleges-340b-pricing-scheme/

[5] Jeffries, E. (2026b, August 31). Milwaukee hospital sues CVS over $18M in alleged 340B diversion. Chicago, IL: Becker’s Hospital Review: Legal & Regulatory Issues. https://www.beckershospitalreview.com/pharmacy/milwaukee-hospital-sues-cvs-over-18m-in-alleged-340b-diversion/

HIV Vaccine Tests in Primates Point to the Potential for Future Developments

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

Research published in Nature found that germline-targeting vaccines administered in primates were the first to generate high numbers of ‘broadly neutralizing ' virus-fighting antibodies against HIV (Steichen et al., 2026).

Source: Nature

This vaccine, a collaboration between La Jolla Institute for Immunology and Scripps Research, works by trying to find rare naïve B cells (white blood cells, also called lymphocytes), and using a series of booster shots to get them to produce “broadly neutralizing antibodies” (bnAbs). Using 24 rhesus macaques split into four groups of six, Steichen et al. produced bnAb lineages in at least 50% of the animals, with individual antibodies reaching up to 67% of the neutralization breadth of the human BG18 antibody.

This practice, commonly referred to as “germline targeting,” essentially preempts the vaccine virus by creating antibodies that could provide between 50% and 90% protection against HIV transmission.

And “could” is the primary word here:

While Steichen et al. attempted to find these rare B cells and get them to produce the desired antibodies, they did not actually test the efficacy of these antibodies in any scientific, clinical, or real-world setting. This means that, while this is an exciting scientific breakthrough, there is little evidence that any near-term vaccines will be developed using this process, in no small part because successfully identifying and targeting these very rare B cells (which are, admittedly, rarer in humans than rhesus macaques) is both incredibly difficult and very much a trial-and-error process that seems to be reliant upon individual animal genetics.

Exciting news, to be certain.

Source: CDC

In many ways, however, Pre-Exposure Prophylaxis (PrEP) provides similar prevention efficacy, with Yeztugo (Gilead Sciences) showing up to 100% efficacy in biological females in one trial and 96% in a second, primarily male drug-trial cohort (Patel et al., 2025).

While PrEP is not a vaccine regimen, it does provide excellent protection against the acquisition of HIV! 

The development of an HIV vaccine presents significant challenges due to the virus's rapid mutations, its ability to integrate into the host's DNA, and its mechanisms for evading the immune response. Conventional vaccines function by training the immune system to identify consistent pathogen features. In contrast, HIV employs strategies that counter this approach. Although research from the La Jolla Institute demonstrates potential, it remains, under specific circumstances, the most recent effort aimed at eradicating HIV.

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] Patel, R. R., Hoover, K. W., Lale, A., Cabrales, J., Byrd, K. M., & Kourtis, A. P. (2025, September 18). Clinical Recommendation for the Use of Injectable Lenacapavir as HIV Preexposure Prophylaxis — United States, 2025. MMWR, 74(35), 541-540 https://www.cdc.gov/mmwr/volumes/74/wr/mm7435a1.htm

[2] Steichen, J. M., Madden, P. J., Flynn, C. T., Phulera, S., Shil, M., Kalyuzhniy, O., Liguori, A., Kifude, C., Sewall, L. M., Cottrell, C. A., Ma, K. M., Baboo, S., Diedrich, J. K., McKenney, K., deCamp, A. C., Carnathan, D. G., Phung, I., Ramezani-Rad, P., Marina-Zárate, E., Freeman, B., … Schief, W. R. (2026, June 30). Vaccination elicits HIV broadly neutralizing antibodies in primates. Nature, 656, 723-733. https://doi.org/10.1038/s41586-026-10837-5

Are Medicaid Work Requirements an Attempt to Destroy America’s Social Safety Nets?

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

On January 1st, 2027, Americans enrolled in state Medicaid programs will be required by federal law to work, enroll in half-time education, complete community service hours, or participate in a work program for 80 hours per month in order to maintain coverage (Centers for Medicare and Medicaid Services, 2026). While some exemptions exist, advocates worry that qualifying for those exemptions, reporting work or volunteer hours, and maintaining coverage will result in unacceptable coverage lapses for roughly 600,000 Americans (Altman, 2024).

Source: McCourt School of Public Policy at Georgetown University

Make no mistake:

Work requirements for social safety programs are not designed to root out waste, fraud, or abuse; that has left many advocates asking if they are fundamentally and purposefully designed to create such high administrative burdens that poor Americans are forced off of the programs those implementing the work requirements openly hope to destroy (Ives-Rublee & Musheno, 2025).

Moreover, more than half of current Medicaid enrollees are unaware that work requirements are being implemented, despite state and federal efforts to inform them, and just over one-quarter of enrollees report hearing about them but were unsure of the details (Olsen, 2026).

And who, frankly, can blame them for being unaware?

Because of the nature of the Medicaid program—federally funded, but administered at the state level—getting a good grasp on what requirements are going to be implemented and where.

The Kaiser Family Foundation (KFF) has created a relatively comprehensive dashboard to track the implementation of the Medicaid changes enacted by the One Big, Beautiful Bill Act (OBBBA). The dashboard can be accessed using the following link:

• Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements

Source: Kaiser Family Foundation

With those issues established, let’s take some time to review what has advocates so concerned:

Medicaid Work Requirement Exemptions

The Centers for Medicare and Medicaid Services (CMS) has released some guidance regarding exemptions to the upcoming work requirements, listing the following categories of people as being exempt:

• Former foster care youth;
• American Indians and Alaska Natives; 
• Parents, guardians, caretaker relatives, or family caregivers of a dependent child 13 years of age and under, or a disabled individual;
• Veterans with a total disability rating;
• Medically frail or otherwise have special medical needs that significantly impair their ability to comply with the requirement;
• Meet the TANF work requirements or are a member of a household receiving SNAP benefits and are not exempt from the SNAP work requirements;
• Participants in a drug or alcohol rehabilitation or treatment program;
• Inmates of a public institution; and
• Pregnant or eligible for postpartum coverage in their state.

States may also opt to provide additional short-term exemptions for hardship, including those who are:

• Receiving certain medical services such as inpatient hospital or nursing facility services; 
• Residing in a county in which there is an emergency or disaster declared by the President;
• Residing in a county with a high unemployment rate; or
• Traveling outside of their community for an extended period of time for medical services for a serious or complex medical condition for themselves or their dependent (CMS, 2026)

According to The Commonwealth Fund:

H.R. 1’s criteria for medical frailty almost exactly parallel the Alternative Benefit Plan (ABP) definition. Both definitions must at least include people who meet Social Security Administration (SSA) disability criteria or have a substance use disorder, “disabling” mental disorder, “serious or complex” medical condition, or physical, intellectual, or developmental disability that “significantly impairs” their ability to perform an activity of daily living (Musumeci et al., 2025).

Source: The Commonwealth Fund

As Musumeci et al. clarify, the SSA eligibility criteria do not incorporate the most recent developments in medicine or knowledge about disability, and those living with chronic conditions, including diabetes, heart failure, and lung disease, do not currently qualify as being “disabled” by the SSA, even though such chronic ailments can be wholly debilitating.

Tim Horn, Director of Medication Access at the National Alliance of State and Territorial AIDS Directors (NASTAD), openly stated at ADAP Advocacy’s recent Fireside Chat in Pittsburgh, Pennsylvania, that there are no exemptions for people living with HIV/AIDS (PLWHA), and that there is little clarity from states regarding whether or not self-attestation will continue to qualify as “proof of work.”

ADAP Advocacy always believes, but does not expect, that the Trump Administration should create specific exemptions for people living with chronic illnesses. The reality, however, is that we have come to expect only the worst from an administration whose members are openly hostile to the poor, the sick, the old, and the frail! 

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] Altman, D. (2024, December 17). Making Sense of Medicaid Work Requirements. Menlo Park, CA: KFF. https://www.kff.org/from-drew-altman/making-sense-of-medicaid-work-requirements/

[2] Centers for Medicare and Medicaid Services. (2027, June 01). Medicaid Community Engagement Requirement for Certain Individuals Interim Final Rule with Comment Period [CMS-2454-IFC]. Baltimore, MD: United States Department of Health and Human Services: Centers for Medicare and Medicaid Services: Newsroom: Fact Sheets. https://www.cms.gov/newsroom/fact-sheets/medicaid-community-engagement-requirement-certain-individuals-interim-final-rule-comment-period-cms

[3] Ives-Rublee, M. & Musheno, K. (2025, July 03). The Truth About the One Big Beautiful Bill Act’s Cuts to Medicaid and Medicare. Washington, DC: Center for American Progress: Article. https://www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/

[4] Musumeci, M., Rao, P., Crays, A., & Shachar, C. (2025, December 18). How Medical Frailty Exemption Policies Can Offer a Lifeline to People with Disabilities and Chronic Illnesses When Medicaid Work Requirements Are Implemented. New York, NY: The Commonwealth Fund: https://www.commonwealthfund.org/blog/2025/how-medical-frailty-exemption-policies-can-offer-lifeline-people-disabilities-and-chronic

[5] Olsen, E. (2026, June 08). Over half of Medicaid enrollees say they’re unaware of upcoming work requirements. Newton, MA: Healthcare Dive: News. https://www.healthcaredive.com/news/over-half-medicaid-enrollees-unaware-work-requirements-health-management-academy-survey/822228/