Connecticut’s Misguided Medicaid Proposal Places People Living with HIV/AIDS at Risk

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

The Office of Connecticut Governor Ned Lamont released its Fiscal Year 2027 Recommended Budget Adjustments document (Office of Policy and Management, 2026), in which they recommend removing antiretroviral medications used to treat HIV from the Medicaid exclusion list and adding them to the state’s Preferred Drug List (PDL). Earlier this year, Colorado’s Department of Health Care Policy and Financing (HCPF) considered modifying its protected drug classes and allowing prior authorization for select drugs, a move that threatens to undermine that progress.

Photo Source: SHAHRZAD RASEKH / CT MIRROR

This week, ADAP Advocacy joined HealthHIV in issuing a joint statement on the proposal. Both organizations submitted public comment to the Connecticut General Assembly, maintaining that the health of Connecticuters living with HIV/AIDS is being put at risk if the protected drug class is weakened by adding antivirals to the state’s PDL. To read the public comment, click here.

What is a Medicaid Drug Class Exemption?

At issue in Connecticut is the exemption of medications used to treat HIV/AIDS from being included on the state’s PDL.

An “exemption,” in this case—also known as an exclusion or an exception—means that the medications are considered necessary for patients’ continued good health or survival, and therefore should not be included on the PDL, a tool that is specifically designed to restrict which medications will be covered for patients by limiting coverage to medications for the purpose of cutting costs or limiting expenditures. Exemptions are usually applied to entire classes of drugs and typically include medications used to treat HIV, cancer, and epilepsy. This practice is commonly referred to as the Protected Drug Class (PDC).

Exemptions can be whole—as is the case with medications used to treat HIV—or class-specific, such as medications used to treat mental health issues and epilepsy, in which cases prescriptions are not subject to step-therapy requirements that would require patients to try other medications prior to being prescribed the one they actually need.

Photo Source: MedicareFAQ

Why Adding Medications to Treat HIV to the PDL is a Bad Idea

When a class of medications is exempted from inclusion on a PDL, medications in that class cannot be subject to prior authorization (PA) requirements, patients are able to access the medications that work best to treat their specific strain of HIV, and patients are not forced to endure delays or administrative red tape that might prevent them from accessing and taking the medications they need to stay alive.

In its budget adjustment document, Connecticut has made a craven attempt to justify including HIV medications on the PDL by suggesting—incorrectly—that medical advances in HIV therapies merit this change:

Now, over two decades later, there have been significant advances in the treatment of HIV and, in recognition of this, the Governor is proposing to lift the current restrictions and include antiretroviral medications on the preferred drug list. This will not only allow the state to receive supplemental rebates on these drugs, but it will also allow for better management of these medications as their inclusion on the preferred drug list will help to ensure practitioners are aligning with clinical criteria and best practices (OPM, 2026).

Not only is this assumption wildly incorrect, but it also amounts to medical malpractice by the State of Connecticut. And all so the state can reap drug rebates to offset expenditures.

Advancements in the quality, tolerability, and efficacy of HIV treatment regimens do not mean that every patient’s HIV can be treated with the same medication.

HIV—a retrovirus that uses reverse transcriptase enzymes to turn its ribonucleic acid (RNA) into deoxyribonucleic acid (DNA), making itself compatible with a person’s own DNA—evolves extremely rapidly, exhibiting the highest recorded biological mutation rate of any organism currently known to science. This is largely due to the reverse transcriptase process, which is prone to errors during viral replication (Andrews & Rowland-Jones, 2017).

In lay terms, this means that medications used to inhibit the reverse transcriptase process—nucleoside reverse transcriptase inhibitors (NRTIs, such Truvada) and non-nucleoside reverse transcriptase inhibitors (NNRTIs, such as rilpivirine, used as part of the Cabenuva long-acting injectable regimen)—are vital for not only maintaining viral suppression, but for ensuring that the HIV virus, itself, is not given a chance to mutate.

What this means for patients is that, once they begin treatment for HIV, lapses in treatment can lead to the HIV virus mutating to create multidrug-resistant strains of the virus. Essentially, if patients suddenly stop taking a medication without replacing it with another NRTI or NNRTI, they risk developing a strain of HIV that is more difficult and more expensive to treat.

Photo Source: Medwave

What Can People Do to Prevent These Changes?

Under current Connecticut law, medications to treat HIV are exempt from inclusion on the PDL precisely because of the nature and rapid mutation of the HIV virus. Changing this drug class exemption literally places the lives of not only people currently living with HIV/AIDS at risk, but also those who might contract a multidrug-resistant strain of HIV from someone whose medications were delayed or no longer covered by Connecticut’s Medicaid program.

Alex Garbera, a long-term survivor of the HIV/AIDS epidemic and patient advocate residing in Connecticut, stated:

“Under current law, classes of antiretroviral drugs are exempt from prior authorization requirements and cannot be included on preferred drug lists. But what the Governor is proposing undermines that protection. PDLs, under the cloak of saving money, may be selecting drugs that are not based on patient needs but on the number of rebates received by the state from drug manufacturers. Sadly, prior authorization is far too common but still imposes an administrative burden on providers, can cause delays in obtaining needed medication, and could result in denial, subject to an appeal process. In my humble opinion, I would say keep the current law exactly as it is for HIV medications, given the complicated medical issues involved.”

For full Bill information, visit:

https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=HB05040&which_year=2026#

To locate your CT State Legislators, go to:

https://www.cga.ct.gov/asp/menu/cgafindleg.asp

To contact the CT Governor's office, visit:

https://portal.ct.gov/governor/contact-the-governor?language=en_US

The HIV Medicine Association (HIVMA) published an important fact sheet, outlining the potential harm done to HIV-positive patients by allowing prior authorization with HIV medicines, which would be allowed by states adding antivirals to PDLs. ADAP Advocacy will continue to monitor this situation, as well as monitor actions that may be taken in other states that place patients at risk.

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] Andrews, S. M. & Rowland-Jones, S. (2017). Recent advances in understanding HIV evolution. F1000Research, 6, 597. https://doi.org/10.12688/f1000research.10876.1

[2] Office of Policy and Management. (2026, February 04). FY 2027 recommended budget adjustments. Hartford, CT: State of Connecticut: Office of Policy and Management: Budget Document Home. https://portal.ct.gov/-/media/opm/budget/2027-midterm/governors-budget-2027-web-version-3-5-26.pdf?rev=8fedbe3df5384f6fa74c78846ec50017&hash=626EFF74CC89DC9E3949C627466B69D9