Washington residents on Apple Health, the state's Medicaid program, will now receive coverage for all FDA-approved HIV antiviral medication without having to make prior authorization requests or undergo step therapy — which forces patients to test other medications before insurance approval, sometimes against their doctor's advice. Gov. Bob Ferguson signed Senate Bill 5577 into law on April 4, which was sponsored by Snohomish County's Sen. Marko Liias, who is Gay.

"This brings us one step closer to eradicating HIV and AIDS in Washington," Liias said. "Now patients statewide will continue to have access to antiviral drugs without unnecessary barriers. We know this policy reduces transmission and keeps people healthy, and I'm thrilled to see it signed into law."

Over 1.8 million adults and children in Washington are enrolled in Apple Health. This law applies to Apple Health patients enrolled in both fee-for-service and managed-care plans. This coverage will also be required for all patients renewing or jump-starting their managed-care plans. Section 2 of SB 5577, as signed into law, reads:

"This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2025."

Washington state HIV data
Apple Health recipients fall low on the income scale, and poverty has a direct impact on one's health. Those living in the poorest parts of each Washington state county had over two times the risk of receiving an HIV diagnosis compared to the wealthiest area of the county, according to the Washington Department of Health's 2024 Health Equity Report, which pertains to 2023 data it compiled and analyzed. Furthermore, the report states that the average cost of HIV treatment in the United States is about $26,000 per year.

According to the DOH's 2024 HIV Surveillance Report, which claims to have the most up-to-date HIV diagnosis data in Washington, cisgender men and men who have sex with men make up a majority of new HIV cases. While cases among these populations dropped in 2023, the overall number of new HIV diagnoses remained stable from the prior year.

The total number of new HIV cases in 2023 (408) increased by 24% among those with heterosexual contacts, totaling 145. Of the total cases, 25-34-year-olds were the most impacted age group, with 153 reported cases.

The Black community remains disproportionately impacted: 125 new HIV cases, 62 of which were in US-born, while 60 were foreign-born. White people accounted for 229 cases.

The highest rates of new HIV diagnoses were in King County (42%, or a total of 170 cases). Pierce County followed with 15%, or 61 cases.

Testing and treatment for those without insurance
Since 2019, the rate of Washington residents who did not have health insurance dropped from 6.1% to 4.8% in the spring of 2023, according to an Office of Financial Management Health Care Research Center brief, published in January 2025.

COVID-19 led to expansions in coverage for state Medicaid programs, but those who remain uninsured or lose their employee-sponsored insurance — a fear looming over the heads of Americans during a time of drastic funding cuts and federal firings — are the most disadvantaged by the country's healthcare system, often facing debt as a result.

The first step to getting treatment is knowing your status. While many providers will conduct an HIV test for walk-ins and by appointment, out-of-pocket costs may be prohibitive. However, Seattle's LGBTQ+ Center, formerly known as Gay City, offers free, rapid HIV testing through finger pricks.

The Ryan White Act, a federal program passed by Congress in 1990, provides funds for services, including HIV treatment costs for those who are uninsured. Eligibility requirements are: being a resident of King, Snohomish, or Island County; having a laboratory test result or confirmation from a medical provider that the person is living with HIV; and living at or below 500% of the federal poverty level. For more information, contact Mark Baker at markbaker@kingcounty.gov or call (206) 477-4301.

"[Harborview's] Madison Clinic is home to the UW AIDS Clinical Trials Unit (ACTU), part of a network of sites around the world that receive funding from the National Institutes of Health to conduct research studies on HIV-related treatments in adults," according to UW Medicine.

The trials conducted at Madison Clinic study the best starting treatment for newly diagnosed HIV patients, and for those that are medication-resistant to HIV. Other trials conducted there include uncovering the best management options for those who have complications from HIV or its treatments. Call the patient care coordinator at (206) 744-5155 to schedule an appointment.