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Advocates and health officials clash over planned ADAP changes; witnesses urge pause and transparency
Summary
Department of Health modeling and proposed ADAP changes—projected reductions in enrollment, formulary removals, and reliance on manufacturer rebates—prompted urgent public testimony and calls from providers and former program managers for a pause and full financial review ahead of near‑term implementation dates.
During the Appropriations Committee on Health and Human Services meeting, senators and public witnesses pressed the Department of Health over proposed changes to the AIDS Drug Assistance Program (ADAP) that agency modeling says would reduce program coverage.
Surgeon General Ladapo told the committee the department’s proposed approach would change ADAP administration and, based on DOH modeling, reduce the number of individuals receiving medication through ADAP from "about 30,400" to roughly 20,000. "Our estimate is around 20,000 for that," Ladapo said, adding the department has been engaging with federal partners and other states to explore options.
Senator Sharif and other senators asked whether drug manufacturers might provide rebates directly to patients and whether the department had negotiated alternative arrangements. Ladapo acknowledged rebates and Ryan White funds make up a large share of ADAP funding and described rebates as an unstable but significant revenue source; he said the department has had conversations with federal Health and Human Services offices and other stakeholders but has not presented a final alternative funding package in the hearing.
Public witnesses described urgency and a lack of transparency. David Poole, who ran Florida’s ADAP previously, told the committee the transparency portal shows about $120 million in rebate revenue last year and asked the department to account for where those funds went. "It shows there's a $120,000,000 in rebate revenues for last year. Where what happened to that money?" Poole asked.
Dr. Paul Aaron, a retired DOH medical director for HIV/AIDS programs, called the proposed changes a crisis and said the implementation timeline is short. He told the committee two widely used medications—Biktarvy and Descovy—are scheduled to be removed from the formulary and that eligibility would be reduced from 400% to 130% of the federal poverty level; he cited an estimate that roughly 16,000 Floridians could lose coverage. "What is urgently needed is a complete pause while the finances are fully reviewed," Aaron said.
Michael Rayner and other community stakeholders urged immediate collaborative engagement with county health departments, providers and patients, saying the department had not adequately involved community advisory groups as required under federal guidance for similar programs.
Department officials said they are actively working on short‑term runways to give patients time to find alternatives and have met with HRSA and federal partners to explore funding approaches. Officials also stressed that some cost drivers were related to federal‑level changes to premium tax credits and other insurance market shifts.
The committee requested follow‑up information and additional transparency on rebate accounting, the financial modeling behind enrollment changes, and any potential emergency funding solutions. No legislative action or final departmental decision was made during the hearing; senators and witnesses asked the department for additional documentation and stakeholder meetings ahead of any implementation.
