HIV Medications and Medicare Drug Price Negotiations:What You Should Know

In recent months, there has been growing attention around how federal drug price negotiations could affect access to HIV medications. These discussions are part of broader efforts under the Inflation Reduction Act to reduce prescription drug costs for people covered by Medicare. However, some groups are raising questions about how this might impact HIV treatment access, particularly for those relying on programs like the AIDS Drug Assistance Program (ADAP) and 340B.

Under the Inflation Reduction Act, the Centers for Medicare & Medicaid Services (CMS) will begin negotiating the prices of select high-cost prescription drugs covered under Medicare. The goal is to lower out-of-pocket costs for beneficiaries and reduce expenses for the Medicare program.

The first negotiated prices are set to take effect in 2026, with additional drugs added in future years. The selection process is based on criteria such as cost to Medicare, lack of competition, and clinical value.

Why Are HIV Medications Part of the Conversation?

Some HIV medications could potentially be selected for negotiation in future years. This has led to public comments and statements from several advocacy groups — including the ADAP Advocacy Association — expressing concern about potential unintended consequences.

Their concerns focus on how price negotiations might affect the participation of drug manufacturers in programs that help provide affordable access to HIV treatment, such as:

• The AIDS Drug Assistance Program (ADAP), which helps low-income individuals obtain HIV medications

• The 340B Drug Pricing Program, which allows community health clinics to purchase medications at reduced prices to support patient care

What Are the Concerns Being Raised?

Some of the issues raised by stakeholders include:

• Access to medications – If a drug’s negotiated price becomes too low for manufacturers to sustain, they may choose to withdraw the medication from certain programs or limit distribution.

• Program participation – There are concerns that manufacturers may reduce participation in ADAP or 340B, both of which rely on manufacturer pricing agreements.

• Continuity of care – Interruptions in HIV treatment can lead to health complications, including drug resistance or increased risk of transmission.

These concerns have led some organizations to recommend that HIV medications be excluded from the early stages of Medicare price negotiation.

What Happens Next?

CMS continues to receive feedback and revise its approach to implementing drug negotiations. The agency has opened public comment periods and is considering input from a wide range of stakeholders, including healthcare providers, advocacy groups, pharmaceutical companies, and patients.

At this time, no decisions have been made about whether or how HIV medications will be included in the negotiation process.

Why This Matters

HIV treatment access has improved significantly over the past decades thanks to strong public health programs, research advancements, and community-based care. Any changes to how medications are priced, distributed, or covered can affect access — especially for those who depend on programs like ADAP and 340B.

Caring Communities will continue monitoring this issue and keeping our clients and partners informed as new developments occur.

If you have questions about how to access HIV medications or are seeking support, please contact us. We are here to help.