May 29, 2024

Some State ADAP Programs Are Not Covering Long-Acting Injectable HIV Medications 

Promising Long-Acting Injectables for ADAP

In recent years, long-acting injectables (LAIs) have broadened the HIV treatment landscape. This new option is a game-changer for those with HIV who, for various reasons, can’t or won’t use daily pills.

However, a number of AIDS Drug Assistance Programs (ADAPs) across the U.S. do not cover these injectables. According to leadership at the International Association of Providers of AIDS Care and Fast-Track Cities, this is a problem in some U.S. territories, such as Guam and American Samoa, and the following six states:

• Kentucky
• Louisiana
• Missouri
• Oklahoma
• South Dakota
• Texas

Negotiating Treatment of Cabenuva 

States should not use the high cost of the injectables as a reason not to cover them.

While Cabenuva, for example, costs about $40,000 annually, it is well known that each state’s ADAP is empowered to negotiate a more favorable rate on drug prices. While many ADAPs may have a gross expenditure of appropriately $43,000 annually for every client using Cabenuva, their net expenditure after negotiations is substantially less.

Officials in the Texas ADAP recently said that they would have to pay $6.4 million a year to provide Cabenuva alone. However, that figure would only be accurate if all Texas ADAP recipients in the state switched to Cabenuva, which is not likely to happen. ViiV, which makes Cabenuva, estimates that the drug is not likely to exceed 15 percent of market share among HIV drugs.

Additionally, what fiscally conservative administrators are apparently missing is that if a change to LAIs leads to substantially increased viral suppression and better health outcomes, the overall savings in reduced care and treatment would dwarf the financial burden of accommodating LAIs for as many as are interested.

Prioritizing Patient Choice

The Academy is interested in assisting our members and the HIV community at large as we work to push these outlier ADAPs to cover not some but all currently available LAIs. It is essential that we continue to encourage people with HIV who are denied access to LAIs to not give up on this treatment option.

Please contact us at chauncey@aahivm.org as we advocate that each state’s ADAP facilitate your patients’ HIV treatment preferences to end the epidemic.