A bill that would require Medicaid to cover all FDA-approved HIV antivirals has seen early success in the Washington state legislature, most recently being unanimously passed by the Senate's Health & Long-Term Care Committee meeting on February 13. But with Robert F. Kennedy Jr.'s recent confirmation as the Health and Human Services (HHS) secretary, primary bill sponsor Sen. Marko Liias (D-21) is ready to fight like hell to ensure that Washingtonians have access to this life-saving medication.

"Robert F. Kennedy Jr.'s dangerous views threaten to upend the progress we've made toward eliminating HIV in this country," Sen. Liias told the SGN. "Despite whatever conspiracy theories the secretary peddles, he cannot erase the fact that HIV antiviral medications are incredibly effective for reducing transmission."

Senate Bill 5577 states that the Health Care Authority (HCA) — which administers Washington's Medicaid program — should provide coverage for all FDA-approved HIV antiviral medications without prior authorization or step therapy, and that coverage must be provided to state Medicaid recipients who are enrolled in both fee-for-service and managed-care models. This would also apply to those initiating and renewing their Medicaid contracts with the HCA.

The majority of the beneficiaries of Washington's Medicaid, also known as Apple Health, receive coverage for medical services through a managed-care system, which is a prepaid system that delivers care through a provider network under a fixed budget. Fee-for-service models require patients to pay for each service.

Beginning on January 1, 2023, Apple Health fee-for-service and managed-care plans were required to cover all medications used for the treatment of HIV, as well as PrEP, without prior authorization. Step therapy, which wasn't covered under this, is when insurance companies require patients to take certain steps before they will cover medications. This can include forcing patients to try lower-cost prescription medications, even if they aren't as effective.

During the Senate Committee on Health & Long-Term Care's public hearing on February 11, Sen. Liias noted how about 400 people in the state are diagnosed with HIV each year, but that this can be addressed by increasing access to life-saving antivirals, which reduce a person's viral load to practically zero.

"This bill is about making sure that people have access to medication and treatment so that we will stop the spread of this disease and stop people from having to suffer from it in our state any longer," Sen. Liias said at the hearing.

"I'll be closely monitoring the secretary's attacks on these life-saving drugs, especially as SB 5577 progresses, and will continue to advance legislation that ensures that Washingtonians have the medication they need," Sen. Liias told the SGN.

For the 2023—25 biennium, the Washington legislature appropriated funds for the HCA to provide coverage for all FDA-approved HIV antiviral medications without the need for prior authorization.

"Washington has been a leader in expanding access to HIV treatment and preventative care, and that's why SB 5577 seeks to codify what we're already doing and have budgeted for," Sen. Liias added.

HIV denialist oversees federal health agencies

In February the US Senate voted to confirm RFK Jr. as the HHS secretary by a vote of 52-48, with Republican Sen. Mitch McConnell joining Democrats in voting against him, as well as two other of President Trump's cabinet nominees — more than any other Republican senator. Sen. McConnell is a survivor of childhood polio.

"Mr. Kennedy failed to prove he is the best possible person to lead America's largest health agency," Sen. McConnell said.

Kennedy is more than a vaccine denialist: he also believes HIV does not cause AIDS, but rather that recreational substance use, like "poppers," and lifestyle stressors are the cause, according to GLAAD. His relative, Caroline Kennedy, even spoke out prior to the confirmation hearings and urged lawmakers to reject his confirmation.

In his new position, Kennedy now oversees a number of large health agencies, including the Food and Drug Administration, the National Institutes of Health, the Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention.