HIV Spending for Fiscal Year 2026: The Latest Update

Politicians have been working through spending bills and with regards to FY2026 HIV domestic spending, the Congress is looking at a flat bill from the previous year. Just recently, Congress rejected the House Republicans’ spending bill that would have decimated domestic HIV programs by cuts of over $1.7 billion, which would have included the elimination of all HIV prevention programs, the entire Ending the HIV Epidemic initiative, and $525 million, or 20 percent, of the Ryan White HIV/AIDS Care and Treatment Program.¹

The final spending package largely mirrors the bipartisan Senate bill that advanced out of committee in July 2025, reflecting months of negotiations and stakeholder engagement. ¹

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, talks about the challenges around securing the funding and the consequences when things were in limbo.

“It was a tough year, but it looks like the program money will be maintained, and now the agencies such as the Ryan White program and the CDC HIV prevention programs can move forward and spend the money…it's been rough that people were laid off, people resigned, grants stopped. I hope that will end now,” Schmid said. “I've had some conversations with the [Trump] administration, and it looks like they're serious about making sure that money is spent, and that we can continue the Ending the HIV Epidemic initiative.”

His organization is involved in monitoring US policies affecting the prevention and treatment of HIV, viral hepatitis, and other serious health conditions; they communicate with HIV, hepatitis, and other patient communities on key policy issues; and they educate policymakers and the media on efforts to end HIV and hepatitis while improving access to high-quality, affordable healthcare for people with or at risk of chronic illness.

Although Schmid is glad to see the bill working towards passage, flat funding does have its own issues especially as costs to run programs continue to rise.

“We know that medical inflation is high every single year. We know that we want to get more and more people onto care and treatment. And the last couple of years, I know the ADAP [AIDS Drug Assistance Program] program has increased by 19,000 people. With flat funding, that's going to put pressure on the program. How are the states going to provide those drugs? And we want to get more and more people on PrEP—that's going to cost money. And we want to do more testing, and people are living longer. The roles of these programs are not going down, they're going up. And, we want to do better.”

One silver lining in the spending package also includes long-awaited reforms to regulate pharmacy benefit managers (PBMs), which play a significant role in determining prescription drug access and patient out-of-pocket costs. The proposed bill would delink PBM compensation from drug prices in Medicare, require full pass-through of rebates and fees, and impose enhanced transparency and reporting requirements.¹

“The PBMs work with the employer, but they don't get all the information, so now they're going to have to report to the employer—their sponsor—how much they're spending on rebates; how much they're getting on rebates. So, hopefully this will lower prescription drug costs in the United States in the long run,” said Schmid.

Reference
1. Congress funds domestic HIV programs—Trump administration must now implement them. The HIV+Hepatitis Policy Institute. January 20, 2026. Accessed January 28, 2026.
https://hivhep.org/press-releases/congress-funds-domestic-hiv-programs-trump-administration-must-now-implement-them/