ADAP Shortfall Relief - The Nevada Department of Health and Human Services’ Office of HIV (OoH) is requesting ADAP Emergency Relief funding to actively prevent the possibility of implementing an ADAP wait list for People Living with HIV (PLWH). In addition, these funds will assist in the possible funding reduction in available resources for ADAP services, address the increase of client enrollment into ADAP and the increase of health care premiums for 2026. From 2023 to 2025, ADAP experienced an enrollment increase of 13% (3,563 clients in 2023 vs 4,039 clients in 2025). Roughly 98% of all newly diagnosed clients in the state are eligible for ADAP, falling at or below ADAP’s federal poverty level eligibility threshold of 400%. 2023 Nevada Assembly Bill (AB434), which is still affecting the Nevada ADAP’s 340B-generated rebates, coupled with the projected 17.5% increase in 2026 individual/Affordable Care Act (ACA) marketplace premiums and an average 31% increase in premiums for Nevada ADAP’s state approved insurance plans, the requested funds are essential to sustain the provision of core medical services. Specifically, these funds will support Health Insurance Premium and Cost-Sharing Assistance, as well as maintain access to health insurance coverage necessary for the provision of life-sustaining medications. The current population for Nevada based on the Census Bureau for 2024 is 3,210,930. The population is White: 58.83%, Other Race: 11.28%, Two or more races: 10.31%, Black or African American: 9.3%, Asian: 8.34%, Native American:1.24% and Native Hawaiian or Pacific Islander:0.71%. In 2023 there were 13,857 PLWH in the state of Nevada with 560 new HIV Diagnoses. Out of the 560, the top three races were 40 % Hispanic, followed by Black or African American at 26 %, and White at 25 %. Currently, 3,562 PLWH out of the 13,857 are active in the ADAP program which is 25.6 % of the current PLWH population. Nevada ADAP, also known as the Nevada Medication Assistance Program (NMAP), is a State/Territory-administered program authorized under Part B of the Ryan White HIV/AIDS Program (RWHAP) that provides U.S. Food and Drug Administration (FDA)-approved medications to low-income individuals with HIV disease who have limited or no coverage from private insurance, Medicaid, or Medicare. Through the provision of access to HIV medications, ADAPs are a critical component of the continuum of primary care and treatment for People Living with HIV (PLWH). Other RWHAP programs work in conjunction with State/Territory ADAPs to bring people into a system of care and provide them with quality treatment and services. OoH is requesting ADAP Emergency Relief funding in the amount of $5,000,000 to prevent having to possibly implement a waitlist, address the reduction in available resources to fund ADAP, and acknowledge the increase in number of clients in the program due to new diagnosis, re-engagement in care, loss of income, and/or loss of health care coverage. In 2023, the State of Nevada passed assembly bill AB434, which went into effect on January 1, 2024. This bill prohibits pharmacy benefit managers and health carriers from discriminating against covered entities or contract pharmacies that participate in the 340B Program, which allows certain healthcare providers to purchase drugs at discounted rates. The bill also imposes limitations on a State of Nevada Department of Human Services program that provides therapeutics to persons with HIV, requiring the program to ensure that covered providers and contract pharmacies participating in the 340B Program receive the full benefit of that participation. This bill has the potential to restrict generation of 340B rebates for ADAP. This restriction will cause a projected deficit of $3,000,000 - $4,000,000 annually to the program. The ADAP ERF funds will be used to maintain access to health insurance premiums and medications through the Health Insurance to Provide Medications service category.
