Watch 02: April 2025
The HIV/HCV Co-Infection Watch is a project of the Community Access National Network (CANN) designed to research, monitor, and report on HIV and Hepatitis C (HCV) co-infection in the United States. The April 2025 Watch includes timely updates herein. To read the project disclaimer and/or methodology, CLICK HERE.
1. FINDINGS
The following is a summary of the key findings for April 2025:
AIDS Drug Assistance Programs:
There are 56 state and territorial AIDS Drug Assistance Programs (ADAPs) in the United States, 47 of which offer some form of coverage for Hepatitis C (HCV) treatment. Of those programs, 45 have expanded their HCV coverage to include the Direct-Acting Antiviral (DAA) regimens that serve as the current Standard of Care (SOC) for Hepatitis C treatment. Two (2) programs offer only Basic Coverage, and nine (9) programs offer No Coverage. One (1) program covers only a single Direct-Acting Antiviral. Three (3) territories – American Samoa, Marshall Islands, and Northern Mariana Islands – are not accounted for in this data. A state-by-state Drug Formulary breakdown of coverage is included in the April 2025 Updates, with accompanying drug-specific maps in Figures 1 – 10.
Medicaid Programs:
There are 59 state and territorial Medicaid programs in the United States, and data is represented for all 50 states and the District of Columbia. As of April 2025, all 50 states and the District of Columbia continue to offer Expanded Coverage for hepatitis C treatment. The coverage landscape has seen several changes since the previous report: Alabama has removed coverage for Sovaldi and Vosevi; Hawaii has removed Sovaldi from the Alohacare Advantage Plus plan; Indiana has added Vosevi coverage with prior authorization; and Minnesota has moved Vosevi from preferred to nonpreferred status. Importantly, all state Medicaid programs have now removed fibrosis restrictions for initial treatment, and no states currently require sobriety as a prerequisite for hepatitis C treatment. Rhode Island remains the only state that does not cover generic Epclusa. A complete state-by-state PDL breakdown of coverage is included in the April 2025 Updates, with accompanying drug-specific maps in Figures 11 – 20.
Patient Assistance Programs:
Our April 2025 analysis of Patient Assistance Programs (PAPs) for hepatitis C treatments reveals a significant development: the HealthWell Foundation has reopened its Hepatitis C fund, which was previously closed due to lack of sufficient funding. The fund now offers co-pay assistance with a maximum award of $30,000 with no minimum reimbursement requirements. This reopening provides an important new avenue of financial support for patients seeking hepatitis C treatment. Other major PAPs maintain their previous status.
Harm Reduction Programs:
Every state and territory in the United States currently provides funding for low-income people living with substance abuse issues to enter state-funded rehabilitation services (National Center for Biotechnology Information, n.d.). Forty-three (43) states, the District of Columbia and two (2) territories currently have Syringe Services Programs (SSPs) in place, regardless of the legality. The states without SSPs are Alabama, Idaho, Kansas, Mississippi, Nebraska, South Dakota, and Wyoming, with Idaho being the most recent change following its repeal of the Syringe and Needle Act (House Bill 617). Fifty (50) states and the District of Columbia have health department distribution programs for Naloxone and/or allow Medicaid coverage of Naloxone. While Federal law prohibits the possession and consumption of certain controlled substances, two (2) states explicitly authorize or have authorized pilot projects for Safe Consumption Sites (SCSs): New York (operational since November 2021) and Rhode Island (opened in 2024 with ribbon-cutting ceremony in December 2024). SCSs exist to provide injection drug users (or those whose prescriptions require injection) with clean syringes and/or in exchange for used ones, offer wound care supplies, allow for injection drugs users to consume drugs, offer infectious disease screening, and other linkage to care opportunities. State Paraphernalia Laws (SPLs) have long prohibited possession of certain drugs use related materials, including harm reduction materials like fentanyl testing strips; forty-eight (48) states have modernized their criminal codes to allow for possession of testing strips and may also have health department programs distributing testing strips. Indiana and Iowa remain the only states where testing strips are still explicitly categorized as illegal paraphernalia, with Indiana's decriminalization bill dying in the Senate despite passing the House. Twenty-five (25) states have Good Samaritan laws or statutes that provide some level of protection for those seeking or giving assistance during a drug overdose, regardless of possession of controlled substance or consumption of illegal or illicit substances. Forty-eight (48) states and the District of Columbia require, through legislative action or regulatory or licensing bodies, that prescribing physicians attend mandatory and continuing opioid prescribing or harm reduction education sessions (otherwise known as Prescriber Education laws). Montana and South Dakota remain the only states without these requirements. A state-by-state program breakdown is included in the April 2025 Updates, with accompanying maps in Figures 21-26.
2. AIDS DRUG ASSISTANCE PROGRAMS (ADAPs) & HCV THERAPIES
Of the 56 respective state and territorial ADAPs, only 8 (KS, KY, OH, UT, VT, GU, PW, VI) do not offer any coverage for HCV drug therapies. States whose formularies are not available on the state-run website have been checked against the most recent National Alliance of State and Territorial AIDS Directors (NASTAD) formulary database (last updated January 1, 2025). The data presented are current as of April 24, 2025.
April 2025 Updates:
Basic Coverage
States with Basic HCV Medications Coverage: AL, AK, AZ, AR, CO, CT, DE, FL, GA, HI, IL, IN, IA, LA, ME, MD, MA, MI, MN, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OK, OR, PA, RI, SC, SD, TN, VA, WA, WV, WY, D.C.
States without Basic HCV Medications Coverage: CA, ID, KS, KY, MS, OH, TX, UT, VT, WI
Territories with Basic HCV Medications Coverage: P.R.
Figure 1. April 2025 ADAP Coverage - Basic
Map Key: Yellow = Basic Coverage; Red = No Basic Coverage/No Information regarding Basic Coverage
Sovaldi
States with Sovaldi Coverage: AZ, CA, CO, HI, IL, IN, IA, LA, ME, MD, MA, MN, NE, NV, NH, NJ, NM, ND, OK, OR, PA, SD, VA, WA, WI, WY, D.C.
States without Sovaldi Coverage: AL, AK, AR, CT, DE, FL, GA, ID, KS, KY, MI, MS, MO, MT, NY, NC, OH, RI, SC, TN, TX, UT, VT, WV
Territories with Sovaldi Coverage: P.R.
Figure 2. April 2025 ADAP Coverage - Sovaldi
Map Key: Yellow = Sovaldi Coverage; Red = No Sovaldi Coverage/No Information regarding Sovaldi Coverage
Harvoni
States with Harvoni Coverage: AZ, AR, CA, CO, CT, DE, FL, HI, ID, IL, IN, IA, LA, ME, MD, MA, MI, MN, MS, NE, NV, NH, NJ, NM, NC, ND, OK, OR, PA, SD, TN, VA, WA, WI, WY, D.C.
States without Harvoni Coverage: AL, AK, GA, KS, KY, MO, MT, NY, OH, RI, SC, TX, UT, VT, WV
Territories with Harvoni Coverage: P.R.
Figure 3. April 2025 ADAP Coverage - Harvoni
Map Key: Yellow = Harvoni Coverage; Red = No Harvoni Coverage/No Information regarding Harvoni Coverage
Zepatier
States with Zepatier Coverage: AL, AZ, AR, CA, CO, FL, GA, HI, IL, IA, LA, ME, MD, MA, MI, MS, NE, NV, NH, NJ, NM, NY, NC, ND, OR, PA, SD, VA, WA, WV, WI, WY, D.C.
States without Zepatier Coverage: AK, CT, DE, ID, IN, KS, KY, MN, MO, MT, OH, OK, RI, SC, TN, TX, UT, VT
Territories with Zepatier Coverage: P.R.
Figure 4. April 2025 ADAP Coverage - Zepatier
Map Key: Yellow = Zepatier Coverage; Red = No Zepatier Coverage/No Information regarding Zepatier Coverage
Epclusa
States with Epclusa Coverage: AZ, AR, CA, CO, CT, FL, HI, ID, IL, IN, IA, LA, ME, MD, MA, MI, MN, MS, MO, NE, NV, NH, NJ, NM, ND, OR, PA, SD, TN, VA, WA, WI, WY
States without Epclusa Coverage: AL, AK, DE, GA, KS, KY, MT, NY, NC, OH, OK, RI, SC, TX, UT, VT, WV, D.C.
Territories with Epclusa Coverage: P.R.
Figure 5. April 2025 ADAP Coverage - Epclusa
Map Key: Yellow = Epclusa Coverage; Red = No Epclusa Coverage/No Information regarding Epclusa Coverage
Vosevi
States with Vosevi Coverage: CA, CO, CT, FL, HI, ID, IL, IN, IA, LA, ME, MD, MA, NE, NV, NH, NJ, NM, ND, OR, SD, TN, WA, WY
States without Vosevi Coverage: AL, AK, AZ, AR, DE, GA, KS, KY, MI, MN, MS, MO, MT, NY, NC, OH, OK, PA, RI, SC, TX, UT, VT, VA, WV, WI, D.C.
Territories with Vosevi Coverage: P.R.
Figure 6. April 2025 ADAP Coverage - Vosevi
Map Key: Yellow = Vosevi Coverage; Red = No Vosevi Coverage/No Information regarding Vosevi Coverage
Mavyret
States with Mavyret Coverage: AL, AZ, AR, CA, CO, CT, FL, GA, HI, ID, IL, IN, IA, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OR, PA, SD, TN, VA, WA, WV, WI, WY, D.C.
States without Mavyret Coverage: AK, DE, KS, KY, OH, OK, RI, SC, TX, UT, VT
Territories with Mavyret Coverage: P.R.
Figure 7. April 2025 ADAP Coverage - Mavyret
Map Key: Yellow = Mavyret Coverage; Red = No Mavyret Coverage/No Information regarding Mavyret Coverage
Pegasys
States with Pegasys Coverage: AL, CA, CT, DE, HI, IA, LA, ME, MD, MA, MI, MN, NE, NV, NH, NJ, NM, NC, ND, OH, OR, PA, RI, SD, WA, WV, WI, WY, D.C.
States without Pegasys Coverage: AK, AZ, AR, CO, FL, GA, ID, IN, KS, KY, MS, MO, MT, NY, OH, OK, SC, TN, TX, UT, VT, VA
Territories with Pegasys Coverage: None/Unknown
Figure 8. April 2025 ADAP Coverage - Pegasys
Map Key: Yellow = Pegasys Coverage; Red = No Pegasys Coverage/No Information regarding Pegasys Coverage
Harvoni (generic)
States with Harvoni (generic) Coverage: AR, CA, CO, CT, FL, GA, HI, IL, IA, ME, MD, MA, MN, NE, NV, NH, NJ, NM, NC, ND, OK, OR, PA, SD, TN, WA, WI, WY, D.C.
States without Harvoni (generic)Coverage: AL, AK, AZ, DE, ID, IN, KS, KY, LA, MI, MS, MO, MT, NY, OH, RI, SC, TX, UT, VT, VA, WV
Territories with Harvoni (generic) Coverage: P.R.
Figure 9. April 2025 ADAP Coverage - Harvoni (Generic)
Map Key: Yellow = Harvoni (Generic) Coverage; Red = No Harvoni (Generic) Coverage/No Information regarding Harvoni (Generic) Coverage
Epclusa (generic)
States with Epclusa (generic) Coverage: AR, CA, CO, CT, FL, GA, HI, IL, IA, ME, MD, MA, MN, NE, NV, NH, NJ, NM, ND, OR, PA, SD, TN, WA, WI, WY
States without Epclusa (generic) Coverage: AL, AK, AZ, DE, ID, IN, KS, KY, LA, MS, MO, MI, MT, NY, NC, OH, OK, RI, SC, TX, UT, VT, VA, WV, D.C.
Territories with Epclusa (generic) Coverage: P.R.
Figure 10. April 2025 ADAP Coverage - Epclusa (generic)
Map Key: Yellow = Epclusa (generic) Coverage; Red = No Epclusa (generic) Coverage/No Information regarding Epclusa (generic) Coverage
April 2025 Notes:
States with Open Formularies: IL, IA, MA, MN, NE, NH, NJ, NM, ND, OH, OR, WA, WY
N.B. – Although Ohio is listed by NASTAD as having an open formulary, both NASTAD’s ADAP Formulary Database and Ohio’s ADAP website indicates that the state does not offer any treatment for HCV.
N.B. – Although North Dakota has adopted an open formulary, they provide only co-pay and deductible assistance for HCV medications.
N.B. – Wyoming's ADAP Open Formulary document, the following disclaimer related to HCV is made: Hepatitis C treatment medications (i.e. Harvoni, Sovaldi, Ribavirin, Zepatier, Epclusa) must be prior authorized. To be eligible, clients must have applied for prior authorization from their insurance plan and the WY ADAP Hepatitis C Treatment checklist must be completed and signed by the provider and client.
Colorado offers five coverage options – Standard ADAP, HIV Medical Assistance Program (HMAP), Bridging the Gap Colorado (BTGC), HIV Insurance Assistance Program (HIAP), and Supplemental Wrap Around Program (SWAP). 'Yes' indications in Figure 1. for Colorado denote that at least one of these programs offers coverage for each respective drug. The Standard ADAP Formulary now includes Vosevi with no restrictions and has removed Pegasys from coverage. Coverage through the Standard ADAP Formulary remains subject to funding availability.
On August 11th, 2023, Georgia’s Department of Public Health issued a notice to Ryan White Part B District Coordinators, reading, in part, “Effective 8/14/2023, care providers will have the ability to order Hepatitis C medications for their eligible ADAP patients without the need for Prior Approval.” Initially covered medications are limited to ribavirn, Zepatier, Mavyret, and generics for Epclusa and Harvoni.
Hawaii’s ADAP notes the following: “Treatment slots for HCV direct-acting antivirals may be limited. Prescriber or pharmacy must call HDAP for slot.”
Louisiana’s ADAP (Louisiana Health Access Program – LA HAP) offers two coverage options – Uninsured (Louisiana Drug Assistance Program – L-DAP) and Insured (Health Insurance Program – HIP). HIP pays for the cost of treatment only if the client’s primary insurance covers the drug under its formulary.
Maine now covers Vosevi with prior authorization.
Minnesota no longer covers Zapatier or Vosevi.
Mississippi’s ADAP formulary no longer covers generic Harvoni nor generic Epclusa.
Texas’s ADAP maintains no HCV coverage, despite a brief period of covering DAAs in 2022.
3. MEDICAID PROGRAMS & HCV THERAPIES
All 50 states and the District of Columbia continue to offer some form of HCV coverage. All 50 States and the District of Columbia have expanded their Preferred Drug Lists to include at least one HCV Direct Acting Agent (DAA).
April 2025 Updates:
Basic Coverage
States with Basic HCV Medications Coverage: AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, IL, IN, IA, KY, LA, ME, MD, MA, MI, MN, MS, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SD, TN, TX, UT, VT, WA, WV, WI, WY, D.C.
States without Basic HCV Medications Coverage: AL, ID, KS, MO, SC, VA
Figure 11. April 2025 Medicaid Coverage - Basic HCV Medications
Map Key: Blue = Basic HCV Medication Coverage; Yellow = No Basic HCV Medication Coverage/No Information regarding Basic HCV Medication Coverage
Sovaldi
States with Sovaldi Coverage: AR, CA, CO, GA, HI, IL, IN, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NY, ND, PA, RI, SD, TX, UT, VT, WA, WI, D.C.
States without Sovaldi Coverage: AK, AL, AZ, CT, DE, FL, ID, IA, KS, ME, NH, NJ, NM, NV, NC, OK, OH, OR, SC, TN, VA, WV, WY.
Figure 12. April 2025 Medicaid Coverage - Sovaldi
Map Key: Blue = Sovaldi Coverage; Yellow = No Sovaldi Coverage/No Information regarding Sovaldi Coverage
Harvoni
States with Harvoni Coverage: AL, AR, CA, CO, GA, HI, IL, IN, KY, LA, MD, MI, MN, MS, MO, MT, NE, NH, NY, ND, PA, RI, SD, TN, TX, UT, VT, WA, WV, WI, D.C.
States without Harvoni Coverage: AK, AZ, CT, DE, FL, ID, IA, KS, ME, MA, NV, NJ, NM, NC, OK, OH, OR, SC, VA, WY.
Figure 13. April 2025 Medicaid Coverage - Harvoni
Map Key: Blue = Harvoni Coverage; Yellow = No Harvoni Coverage/No Information regarding Harvoni Coverage
Zepatier
States with Zepatier Coverage: AL, AR, CA, CO, GA, HI, IL, IN, KY, LA, MD, MI, MN, MS, MO, MT, NE, NH, NJ, NY, ND, OH, PA, SD, TX, UT, VT, WA, WI, WV, D.C.
States without Zepatier Coverage: AK, AZ, CT, DE, FL, ID, IA, KS, ME, MA, NV, NM, NC, OK, OR, RI, SC, TN, VA, WY.
Figure 14. April 2025 Medicaid Coverage - Zepatier
Map Key: Blue = Zepatier Coverage; Yellow = No Zepatier Coverage/No Information regarding Zepatier Coverage
Epclusa
States with Epclusa Coverage: AL, CA, CO, GA, HI, IL, IN, KY, LA, MD, MI, MN, MO, MS, MT, NH, NJ, NY, ND, PA, SD, TN, TX, UT, VT, WA, WV, WI, D.C.
States without Epclusa Coverage: AK, AZ, AR, CT, DE, FL, ID, IA, KS, ME, MA, NE, NV, NM, NC, OH, OK, OR, RI, SC, VA, WY.
Figure 15. April 2025 Medicaid Coverage - Epclusa
Map Key: Blue = Epclusa Coverage; Yellow = No Epclusa Coverage/No Information regarding Epclusa Coverage
Vosevi
States with Vosevi Coverage: AR, CA, CO, CT, FL, GA, HI, ID, IL, IN, KY, LA, MD, MI, MN, MO, MS, MT, NE, NH, NY, NC, ND, OH, PA, SC, SD, TX, UT, VT, WA, WV, WI, D.C.
States without Vosevi Coverage: AK, AL, AZ, DE, IA, KS, NV, NJ, NM, ME, MA, OK, OR, RI, TN, VA, WY.
Figure 16. April 2025 Medicaid Coverage - Vosevi
Map Key: Blue = Vosevi Coverage; Yellow = No Vosevi Coverage/No Information regarding Vosevi Coverage
Mavyret
States with Mavyret Coverage: AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, D.C.
Figure 17. April 2025 Medicaid Coverage - Mavyret
Map Key: Blue = Mavyret Coverage; Yellow = No Mavyret Coverage/No Information regarding Mavyret Coverage
Pegasys
States with Pegasys Coverage: AK, AZ, AR, CA, CT, FL, GA, HI, IL, IN, IA, KY, LA, ME, MD, MI, MN, MS, MT, NE, NV, NH, NJ, NM, NC, OH, OK, OR, PA, RI, SD, TN, TX, VT, WA, WV, WI, D.C.
States without Pegasys Coverage: AL, CO, DE, ID, KS, MA, MO, NY, ND, SC, UT, VA, WY
Figure 18. April 2025 Medicaid Coverage - Pegasys
Map Key: Blue = Pegasys Coverage; Yellow = No Pegasys Coverage/No Information regarding Pegasys Coverage
Harvoni (generic)
States with Harvoni (generic) Coverage: AL, AR, CA, CO, DE, GA, HI, IL, IN, KY, LA, MD, MA, MI, MN, MO, MS, MT, NE, NH, ND, OK, PA, RI, SD, TN, TX, UT, VT, WA, WV, WI, D.C.
States without Harvoni (generic) Coverage: AK, AZ, CT, FL, ID, IA, KS, ME, NM, NJ, NV, NC, OK, OH, OR, SC, VA, WY
Figure 19. April 2025 Medicaid Coverage - Harvoni (generic)
Map Key: Blue = Harvoni (generic) Coverage; Yellow = No Harvoni (generic) Coverage/No Information regarding Harvoni (generic) Coverage
Epclusa (generic)
States with Epclusa (generic) Coverage: AK, AL, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OK, OH, OR, PA, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, D.C.
States without Epclusa (generic) Coverage: RI
Figure 20. April 2025 Medicaid Coverage - Epclusa (generic)
Map Key: Blue = Epclusa (generic) Coverage; Yellow = No Epclusa (generic) Coverage/No Information regarding Epclusa (generic) Coverage
April 2025 Notes:
The following states’ Medicaid programs offer multiple coverage plans for their respective Medicaid clients. The plan highlighted in bold typeface represents the most comprehensive plan with the most drugs covered in the respective state:
Hawaii – (1.) Alohacare Advantage Plus; (2.) HMSA; (3.) Kaiser Permanente; (4.) UnitedHealthcare QUEST Integration; (5.) WellCare
New Jersey – (1.) Aetna; (2.) AmeriGroup NJ (Now Wellpoint); (3.) Horizon NJ Health; (4.) UnitedHealthcare of New Jersey (New Jersey Family Care);
New Mexico – (1.) BlueCross BlueShield of New Mexico; (2.) Presbyterian Centennial Care; (3) Western Sky Community Care
Kentucky has a Unified Medicaid Formulary
Louisiana has a Unified Medicaid Formulary
Ohio – Ohio has a Unified Medicaid Formulary that applies to all MCOs
No data has been made available by the Medicaid programs in the U.S. Territories.
Alabama has removed coverage for Sovaldi and Vosevi which must now go through prior authorization.
Hawaii has removed Sovaldi from the Alohacare Advantage Plus plan.
Indiana has added Vosevi coverage with prior authorization.
Minnesota has moved Vosevi from preferred to nonpreferred.
All state Medicaid programs have removed fibrosis restrictions for initial treatment
There are currently no states that require sobriety as a prerequisite for hepatitis C treatment.
For clarification, if a state requires a complicated prior authorization process or step therapy requiring failure on preferred medications, that is considered ‘no coverage’.
Rhode Island remains the only state that does not cover generic Epclusa.
*Medicaid coverage excludes patients from most drug manufacturer patient assistance programs (PAPs)
4. VETERANS PROGRAMS & HCV THERAPIES
The Veteran's Administration (VA) currently offers coverage for all HCV drugs. This is according to the most recent VA National Formulary, dated May 2021 (U.S. Dept. of V.A., 2021a). The VA Treatment Considerations and Choice of Regimen for HCV-Mono-Infected and HIV/HCV Co-Infected Patients, dated March 2021 (U.S. Dept. of V.A., 2021b) lists the following therapies as preferred treatments:
Abbreviations:
- CTP – Child-Turcotte-Pugh (score used to assess severity of cirrhosis)
- IU/mL – International Units Per Milliliter
- PEG-IFN/IFN – Peginterferon/Interferon
- RAS – Resistance-associated substitutions
Genotype 1:
Treatment-naïve without or with cirrhosis (CTP A):
Pangenotypic regimens
Mavyret: 3 tablets orally daily with food for 8 weeks; may consider 12 weeks in patients with poor prognostic factors
Epclusa: 1 tablet orally daily for 12 weeks
Non-pangenotypic regimens:
Zepatier: 1 tablet orally daily for 12 weeks if GT1a without baseline NS5A RAS or GT1b
Harvoni: 1 tablet orally daily
If HCV-noninfected, non-cirrhotic, and HCV RNA baseline <6 million IU/mL: 8 weeks
If cirrhotic, baseline HCV RNA ≥6 million IU/mL, HIV/HCV-co-infected, or African American: 12 weeks
Consider adding ribavirin in CTP A patients
Treatment-naïve with decompensated cirrhosis (CTP B or C):
Harvoni: 1 tablet orally daily + ribavirin (600 mg/day and increase by 200 mg/day every 2 weeks only as tolerated) for 12 weeks
Epclusa: 1 tablet orally daily + ribavirin (1000 mg/day - <75kg – or 1,200 mg daily - ≥75kg – orally daily in 2 divided doses with food) for 12 weeks; start at lower ribavirin doses as clinically indicated (e.g., baseline Hgb).
Treatment-experienced (NS5A- and SOF-naïve [e.g., failed PEG-IFN/RBV ± NS3/4A PI]) without or with cirrhosis (CTP A)
Pangenotypic regimens:
Mavyret: 3 tablets orally daily with food
If PEG-IFN/RBV-experienced: 8 weeks if non-cirrhotic or 12 weeks if cirrhotic
If NS3/4A PI + PEG-IFN/RBV-experienced: 12 weeks
Vosevi: 1 tablet orally daily for 12 weeks
Non-pangenotypic regimens
Zepatier: 1 tablet orally daily for 12 weeks if GT1b, or if failed only PEG-IFN/RBV and GT1a without baseline NS5A RAS
Harvoni: 1 tablet orally daily for 12 weeks
Treatment-experienced (NS5A-naïve and SOF-experienced) without or with cirrhosis (CTP A)
Mavyret: 3 tablets orally daily with food
If PEG-IFN/RBV + Sovaldi-experienced: 8 weeks if non-cirrhotic or 12 weeks if cirrhotic
If Olysio + Sovaldi-experienced: 12 weeks
Epclusa: 1 tablet orally daily for 12 weeks if GT1b
Vosevi: 1 tablet orally daily with food for 12 weeks if GT1a
Treatment-experienced (prior NS5A-containing regimen) without or with cirrhosis (CTP A)
Mavyret: 3 tablets orally daily with food for 16 weeks if failed only an NS5A inhibitor without NS3/4A PI (e.g., Harvoni)
Vosevi: 1 tablet orally daily with food for 12 weeks
Treatment-experienced with decompensated cirrhosis (CTP B or C)
Epclusa: 1 tablet orally daily + RBV; start at lower RBV doses as clinically indicated (e.g., baseline Hgb);
If NS5A-naïve: 12 weeks
If NS5A-experienced: 24 weeks; NOT FDA approved for 24 weeks
Genotype 2:
Treatment-naïve or treatment-experienced (PEG-IFN/IFN ± RBV or Sovaldi + RBV ± PEG-IFN) without or with cirrhosis (CTP A)
Mavyret: 3 tablets orally daily with food for 8 weeks; 12 weeks if CTP A and treatment-experienced or in patients with poor prognostic factors
Epclusa: 1 tablet orally daily for 12 weeks
Treatment-experienced (NS5A-experienced) without or with cirrhosis (CTP A)
Vosevi: 1 tablet orally daily with food for 12 weeks
Treatment-naïve or treatment-experienced patients with decompensated cirrhosis (CTP B or CTP C)
Epclusa: 1 tablet orally daily + ribavirin; start at lower ribavirin doses as clinically indicated (e.g., baseline Hgb)
If NS5A-naïve: 12 weeks
If NS5A-experienced: 24 weeks
Genotype 3:
Treatment-naïve without cirrhosis or with cirrhosis (CTP A)
Mavyret: 3 tablets orally daily with food for 8 weeks; may consider 12 weeks if cirrhotic or in patients with poor prognostic factors
Epclusa: 1 tablet orally daily for 12 weeks
If CTP A, test for NS5A RAS
Add ribavirin if Y93H RAS present
Treatment-experienced (PEG-IFN ± RBV or Sovaldi + RBV ± PEG-IFN) without or with cirrhosis (CTP A)
Mavyret: 3 tablets orally daily with food for 16 weeks
Treatment-experienced (NS5A-experienced) without or with cirrhosis (CTP A)
Vosevi: 1 tablet orally daily with food for 12 weeks
If CTP A, consider adding ribavirin (no supporting data)
Treatment-naïve or treatment-experienced with decompensated cirrhosis (CTP B or CTP C)
Epclusa: 1 tablet orally daily + ribavirin; start at lower ribavirin doses as clinically indicated (e.g., baseline Hgb)
If NS5A-naïve: 12 weeks
If NS5A-experienced: 24 weeks
Genotype 4:
Treatment-naïve without or with cirrhosis (CTP A)
Pangenotypic regimens
Mavyret: 3 tablets orally daily with food for 8 weeks; may consider 12 weeks in patients with poor prognostic factors
Epclusa: 1 tablet orally daily for 12 weeks
Non-pangenotypic regimens
Zepatier: 1 tablet orally daily for 12 weeks
Harvoni: 1 tablet orally daily for 12 weeks
Treatment-naïve with decompensated cirrhosis (CTP B or C)
Pangenotypic regimen
Epclusa: 1 tablet orally daily + RBV for 12 weeks; start at lower ribavirin doses as clinically indicated (e.g., baseline Hgb)
Non-pangenotypic regimen:
Harvoni: 1 tablet orally daily + ribavirin (600 mg/day and increase by 200 mg/day every 2 weeks only as tolerated) for 12 weeks
Treatment-experienced (Sovaldi-experienced and NS5A-naïve) without or with cirrhosis (CTP A)
Mavyret: 3 tablets orally daily with food for 8 weeks if NS3/4A PI-naïve without cirrhosis, and 12 weeks if NS3/4A PI-experienced or CTP A
Epclusa: 1 tablet orally daily + ribavirin for 12 weeks; start at lower ribavirin doses as clinically indicated (e.g., baseline Hgb)
Treatment-experienced (NS5A-experienced) without or with cirrhosis (CTP A)
Vosevi: 1 tablet orally daily with food for 12 weeks
Treatment-experienced with decompensated cirrhosis (CTP B or CTP C)
Epclusa: 1 tablet orally daily + ribavirin; start at lower ribavirin doses as clinically indicated (e.g., baseline Hgb)
If NS5A-naïve: 12 weeks
If NS5A-experienced: 24 weeks; NOT FDA approved for 24 weeks
5. PATIENT ASSISTANCE PROGRAMS
The drug manufacturers and various national nonprofit organizations offer a variation of patient assistance programs (PAPs) to assist patients in accessing treatments. They include:
Support Path (Gilead Sciences):
Financial Assistance
Provides Co-Pay Coupons for Sovaldi, Harvoni, Harvoni (Generic), Epclusa, Epclusa (Generic), and Vosevi
Co-Pay Coupons cover out-of-pocket costs up to 25% of the catalog price of a 12-week regimen (3 bottles/packages) of Sovaldi, Harvoni, Harvoni (Generic), Epclusa, Epclusa (Generic), or Vosevi
Excludes patients enrolled in Medicare Part D or Medicaid
Insurance Support
Researches and verifies patient’s benefits, and gives information they need about coverage options and policies
Explain Prior Authorization process and works with HCV Specialist’s office so they can submit PA forms to a patient’s insurance company
May be able to provide assistance with appeals process
Website: http://www.mysupportpath.com/
AbbVie Mavyret Co-Pay Savings Card:
Financial Assistance
Patient may be eligible to pay as little as $5
Excludes patients enrolled in Medicare Part D, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs)
NeedyMeds:
NeedyMeds Drug Discount Card
Designed to lower cost of prescription medications by up to 80% at participating pharmacies
Price finder tool for the drug discount card
No eligibility requirements
CANNOT be used in combination with government healthcare programs, but CAN be used IN PLACE of program
CANNOT be combined with other offers
Website: http://ow.ly/fEJo309cJ7Z
The Assistance Fund:
Status: WAITLISTED (accepting patients for waitlist)
Requires provider referral
Copay assistance
Eligibility Criteria:
US citizen or permanent resident
Diagnosed with the disease for which you are applying
Prescribed an FDA-approved treatment for the disease
Have prescription coverage for the prescribed treatment
Meet financial eligibility criteria based upon household income and size
Patient Advocate Foundation Co-Pay Relief:
Status: CLOSED
Maximum award of $4,500
Eligibility Requirements:
Patient must be insured, and insurance must cover prescribed medication
Confirmed HCV diagnosis
Reside and receive treatment in the U.S.
Income falls below 400% of FPL with consideration of the Cost of Living Index (COLI) and the number in the household
Patient Access Network (PAN) Foundation:
Status: CLOSED (not currently accepting applications for new or renewal patients)
Co-Pay Assistance with a maximum award of $3,800
Patients may apply for additional assistance during their eligibility period, subject to availability of funding
Eligibility Requirements:
Must be getting treatment for HCV
Have insurance that covers prescribed HCV medication
Medication must be listed on PAN’s list of covered medications: https://www.panfoundation.org/index.php/en/patients/medications-covered
Income falls below 500% of FPL
Residing and receiving treatment in the U.S. (citizenship NOT required)
Website: https://www.panfoundation.org/index.php/en/patients/assistance-programs/hepatitis-c
HealthWell Foundation:
Status: OPEN
Co-Pay Assistance with a maximum award of $30,000
Minimum Co-Pay Reimbursement Amount: None
Minimum Premium Reimbursement Amount: None
Eligibility Requirements:
Must be being treated for HCV
Have insurance that covers HCV prescribed medication
Income falls below 500% of FPL
Receiving treatment in the U.S.
Website: https://www.healthwellfoundation.org/fund/hepatitis-c/
6. HARM REDUCTION PROGRAMS
Harm Reduction, as it relates to opioid abuse and HCV, are measures designed to serve as preventive or monitoring efforts in combating opioid prescription drug and heroin abuse, and as an effect, helping to prevent the spread of HCV and HIV. The Co-Infection Watch covers the following measures: Syringe Exchange, Expanded Naloxone Access, State Authorized Safe Consumption Sites, Updated Paraphernalia Laws (allowing for possession of substance testing strips), Good Samaritan Laws, Required Prescriber Education. (Editor’s Note: Program descriptions provided herein).
April 2025 Updates:
Syringe Exchange
Syringe Services Programs (SSPs) exist to provide injection drug users (or those whose prescriptions require injection) with clean syringes and/or in exchange for used ones. (N.b. – states listed as "at least one SSP…” indicate only that a Syringe Services Program (SSP) exists within the state, regardless of the legality of SSPs under state law).
States with Syringe Exchange: AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, IL, IN, IA, KY, LA, ME, MD, MA, MI, MN, MO, MT, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, UT, VT, VA, WA, WV, WI, D.C.
States without Syringe Exchange: AL, ID, KS, MS, NE, SD, WY
Territories with Syringe Exchange: Puerto Rico, U.S. Virgin Islands
Figure 21. April 2025 Syringe Exchange Coverage
Map Key: Purple = Syringe Exchange(s); Red = No Syringe Exchange(s); Grey = No Information
Expanded Naloxone
Naloxone is a drug used to counteract the effects of opioid overdoses. Expanded Access refers to having statutes or state standing orders in place that allow pharmacies to dispense naloxone without a prescription. This means those in danger of overdose, those who are caregivers for them, or anyone who may come in contact with those in danger of overdose can walk into a pharmacy and obtain naloxone without a prescription. Removing the requirement of a patient-doctor relationship via prescription enhances access.
States with Expanded Naloxone: AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MO, MS, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, D.C.
States without Expanded Naloxone: None
Territories with Expanded Naloxone: Unknown
Figure 22. April 2025 Expanded Naloxone Coverage
Map Key: Purple = Expanded Naloxone; Red = Restricted Naloxone; Gray = No Information
State Authorized Safe Consumption Sites
Federal prohibits the distribution, possession, and consumption of certain controlled substances. Safe Consumption Sites (SCSs) exist to provide injection drug users (or those whose prescriptions require injection) with clean syringes and/or in exchange for used ones, offer wound care supplies, allow for injection drugs users to consume drugs, offer infectious disease screening, and other linkage to care opportunities. This section monitors state authorized safe consumption site programs and pilot projects related to safe consumption sites.
States with Safe Consumption Sites: NY, RI
States without Safe Consumption Sites: AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MO, MS, MT, NE, NV, NH, NJ, NM, NC, ND, OH, OK, OR, PA, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, D.C.
Territories with Safe Consumption Sites: None
Figure 23. April 2025 State Authorized Safe Consumption Sites
Map Key: Purple = States with sites; Red = States without sites
Updated Paraphernalia Laws
State paraphernalia laws have long prohibited possession of certain drugs use related materials, including harm reduction materials like fentanyl testing strips. Some states have modernized their criminal codes to allow for possession of testing strips and may also have health department programs distributing testing strips.
States with Updated Paraphernalia Laws: AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, KS, KY, LA, MD, MA, ME, MI, MN, MO, MS, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, UT, VT, VA, WA, WV, WI, WY, D.C.
States without Updated Paraphernalia Laws: IN, IA
Territories with Updated Paraphernalia Laws: Unknown
Figure 24. April 2025 Updated Paraphernalia laws
Map Key: Purple = Without Updated Laws; Red = With Updated Laws; Gray = No Information
Expanded Good Samaritan Laws
Expanded Good Samaritan Laws are laws that are designed to protect persons seeking emergency services for drug overdoses from drug-related charges or prosecutions, regardless of possession or consumption of illegal, illicit substances, or drug paraphernalia. Good Samaritan laws may or may not provide protection to those currently under parole or probation. Good Samaritan laws listed do NOT prohibit arrest.
States with Expanded Good Samaritan Laws: AZ, CA, CT, DE, Fl, GA, HI, ID, IL, KY, LA, MD, MN, MS, MO, MT, NB, NV NJ, NM, NY, ND, PA, RI, TN
States without Expanded Good Samaritan Laws: AL, AK, AR, CO, IN, IA, KS, ME, MA, MI, NH, NC, OH, OK, OR, SC, SD, TX, UT, VT, VA, WV, WI, WY
Territories with Expanded Good Samaritan Laws: Unknown
Figure 25. April 2025 Good Samaritan Laws Coverage
Map Key: Purple = Good Samaritan Laws; Red = No Good Samaritan Laws; Gray: No Information
Prescriber Education Required
States that require/do not require through legislative action or regulatory or licensing bodies that prescribing physicians undergo special training in addition to or as part of their initial education to become prescribers related to safer controlled substance and/or pain management prescribing and utilization practices.
States with Prescriber Education Required: AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MO, MN, MS, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, UT, VT, VA, WA, WV, WI, WY, D.C.
States without Prescriber Education Required: MT, SD
Territories with Prescriber Education Required: Unknown
Figure 26. April 2025 Prescriber Education Required Coverage
Map Key: Purple = Prescriber Ed Required; Red = No Prescriber Ed Required; Gray = No Information
April 2025 Notes:
Metrics for Mandatory PDMP reporting, Doctor Shopping Laws, Physical Exam, ID Requirements, and Lock-in Pharmacy programs have been permanently deleted from the Watch due to redundancy or outdatedness.
Metric definition for Expanded Naloxone was updated. Medicaid covers naloxone in all states. However, even though naloxone was previously made available OTC federally, some states still required a prescription for it at the pharmacy. Expanded Naloxone designation also addresses issues such as its availability in schools and other public places, the state-by-state variation in who other than pharmacists is allowed to dispense naloxone, and more.
Added metrics for monitoring state paraphernalia laws regarding possession of testing strips and state authorized safe consumption sites, including legislatively authorized pilot projects.
NC, ND, and VT still have controlled substance testing equipment on their drug paraphernalia law statues but provide a carve-out to allow testing strips.
Metric definition for Prescriber Education has been updated to exclude “recommended” and only reflect those states which have laws or licensing board requirements of initial and/or continuing education for prescribers with regard to pain management and/or the prescription of controlled substances.
Some states have general requirements regarding “controlled substances”, some states are explicit with regard to category of controlled substance or type of controlled substance (ie. “opioids”).
This adjustment clarifies that MT and SD are the only states that do not require opioid specific and/or pain management specific and/or controlled substances prescribing education by law or licensing institution in either core or continuing education for providers.
This adjustment clarifies that KS, MO, and ND do require opioid specific and/or pain management specific and/or controlled substances prescribing education by law or licensing institution in either core or continuing education for providers.
The immunity provided under Good Samaritan Laws only applies when there are personal usage amounts of drugs present. It does not apply when there are distribution-level amounts.
In March 2024, Idaho repealed its five-year-old Syringe and Needle Act by passing House Bill 617. The governor signed it into law for it to go into effect July 1st.
Idaho’s legalization of fentanyl strips officially went into effect July 1, 2024.
Indiana passed a bill to decriminalize fentanyl testing strips in the House. However, the bill died in the Senate.
Nebraska’s standing order for Naloxone is set to expire August of 2024.
Rhode Island approved the state’s first safe consumption site. It will open in Summer 2024 at 45 Willard Avenue, next to the Rhode Island Hospital Campus in Providence. (UPDATE: The site held its ribbon cutting ceremony in December 2024)
Wyoming law does not explicitly outlaw fentanyl testing strips, however they have not been widely distributed.
The DEA's COVID-19-based waiver of in-person exams that was extended through December 31, 2024, has now been extended again through December 31, 2025, as announced in the "Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications." The DEA and HHS stated they "continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations" while extending the current flexibilities.
Additionally, on January 16, 2025, the DEA announced "three new rules to make permanent some temporary telemedicine flexibilities established during the COVID-19 public health emergency while also establishing new patient protections." These proposed rules, currently open for public comment, would create special registration categories for telemedicine prescribing after the temporary extension expires.
7. LATEST NEWS
Former Trump Official Warns of Reversals in HIV Progress Due to Budget Cuts - Brett Giroir, who served as assistant secretary for health during Trump's first term, urges the president to preserve funding for HIV prevention efforts that began during his previous administration. The Ending the HIV Epidemic initiative had achieved significant progress, with a 12% reduction in new HIV cases from 2018 through 2022, including an 18% decrease among Black Americans and a 16% decline in infection rates in the South. However, recent funding cuts and organizational changes threaten this progress, including layoffs of 150 employees in the Centers for Disease Control & Prevention’s (CDC) HIV prevention office, the elimination of the Office of Infectious Disease and HIV/AIDS Policy, cuts of approximately $750 million in HIV-targeted grants from the National Institutes of Health (NIH), and a leaked 2026 budget draft suggesting plans to eliminate the Ending the HIV Epidemic program entirely. HIV advocates have expressed concern that new administration officials may be unaware of the previous administration's commitments to addressing HIV.
$60 Million HIV Drug Fraud Scheme Uncovered in Florida - Adam Brosius, a 60-year-old Delray Beach resident, has pleaded guilty to conspiracy to commit wire fraud involving black market HIV medications. Through his companies Worldwide Pharma Sales Group and Safe Chain Solutions, Brosius admitted to a $60 million scheme that operated from September 2020 through August 2021, involving the distribution of misbranded and adulterated HIV drugs to retail pharmacies. The operation acquired diverted prescription drugs from patients who didn't consume their medications, then reintroduced them into the wholesale marketplace with falsified documentation to conceal their origins. In some cases, bottles labeled as specific HIV medications actually contained entirely different drugs, including an anti-psychotic medication that was dispensed to a patient. Brosius faces sentencing on August 29, while his business partners Patrick and Charles Boyd are facing separate wire fraud and misbranded drug charges.
Model Study Shows Different HIV Cure Strategies Could Have Varying Impacts on Transmission - Using a mathematical model calibrated to data from men who have sex with men (MSM) in the Netherlands, researchers have evaluated how different HIV cure approaches might affect transmission dynamics. The study assessed two scenarios: HIV remission (virus suppression without ongoing ART) and HIV eradication (complete virus removal). Findings show that sustained HIV remission or HIV eradication could reduce new HIV infections by up to 60% over ten years compared to scenarios without a cure. However, transient HIV remission with a risk of viral rebound could potentially increase new infections if rebounds are not closely monitored, even undermining existing HIV control efforts. The researchers emphasize that cure characteristics must be carefully aligned with public health objectives to maximize benefits for ending the HIV epidemic.
WHO Mobilizes to Protect HIV Services Amid Major Funding Cuts - The World Health Organization's (WHO) Department of Global HIV, Hepatitis and STIs Programmes (HHS) has implemented a strategic response plan to address unprecedented suspensions and reductions in official development assistance for health and HIV programs. A rapid WHO survey of 36 countries has already identified disruptions in key HIV services, with 48% of 90 countries reporting moderate to severe disruptions in HIV services and 36% reporting problems with medicine availability. The WHO has established a five-pillar approach focused on strategic information, service delivery, country support, community engagement, and communication to mitigate impacts. "Now more than ever, we have an opportunity to support ministries of health by offering timely guidance, tools, and global collaboration tailored to country needs," said Dr. Meg Doherty, Director of HHS, emphasizing the organization's commitment to ensuring essential services reach those most in need despite financial uncertainty.
Trump Administration Budget Proposal Could Significantly Scale Back US HIV Response - A U.S. Department of Health & Human Services (HHS) leaked budget document reveals plans to eliminate the Ending the HIV/AIDS Epidemic (EHE) Initiative and the Minority AIDS Initiative (MAI), which had provided critical funding to reduce new HIV infections and address disparities. The Ryan White HIV/AIDS program would be moved to a new "Administration for a Healthy America" with level funding for grants to cities and states, including the AIDS Drug Assistance Program, but would see its overall budget reduced by $239 million through elimination of dental services, training centers, and demonstration programs. The Centers for Disease Control & Prevention’s (CDC) HIV prevention funding appears at risk, with the Division of HIV Prevention potentially being eliminated and its nearly $1 billion budget consolidated into a smaller grant program focused on infectious diseases more broadly. The National Institutes of Health (NIH), which has supported the world's most extensive HIV research portfolio, faces an overall 40% budget reduction, potentially affecting its $3.3 billion HIV research funding.
Public Health Expert Warns of Potential HIV Resurgence Due to Funding Cuts - A new analysis raises alarm about current policy changes that could reverse decades of progress against HIV/AIDS. The article details how the current administration has removed key HIV prevention resources, including PrEP information from the CDC website, and disabled access to the Ryan White HIV/AIDS Program Compass Dashboard. According to WHO Director-General Tedros Adhanom Ghebreyesus, disruptions to HIV programs globally "could lead to over 10 million additional HIV cases and three million HIV-related deaths." The author draws parallels to the 1980s when HIV/AIDS became the second leading cause of death among men 25-44 years of age, warning that defunding prevention, testing, and treatment programs risks repeating history after 40 years of hard-won progress in reducing infections and deaths.
PEPFAR Faces Severe Disruption as Foreign Aid Review Continues - The President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to address a single disease, has been significantly impacted by recent changes to U.S. foreign assistance. Following a 90-day foreign aid review and stop-work order that froze payments and services, PEPFAR received only a limited waiver allowing continuation of certain "life-saving HIV services" while excluding critical prevention programs and services for vulnerable children. A recent survey found that 60% of PEPFAR recipients had laid off staff, 36% had completely closed operations, and 86% reported clients would lose access to HIV treatment within one month if the freeze continued. Market assessments in PEPFAR countries identified disruptions to HIV testing in 10 countries and risks of ARV stockouts in 8 countries. Modeling studies estimate that even a 90-day PEPFAR funding pause could result in over 100,000 excess HIV-related deaths over a year, while ending the program entirely could lead to up to 11 million additional new HIV infections and nearly 3 million additional AIDS-related deaths by 2030.
CDC's Vital Hepatitis Lab Shuttered Amid Federal Layoffs, Halting Outbreak Investigations - The Centers for Disease Control & Prevention (CDC) has fired all 27 scientists at its Division of Viral Hepatitis as part of broader federal layoffs, abruptly halting critical work on ongoing hepatitis outbreaks in multiple states. The lab was investigating a hepatitis C outbreak in Florida traced to a pain clinic where a doctor was improperly reusing injection vials. Still, this work stopped on April 1st when scientists received termination notices. According to CDC employees, the lab performs unique genetic tracing that is not conducted by any other laboratory in the United States or globally, making it irreplaceable for tracking disease sources. Current hepatitis investigations in Florida, Oregon, Pennsylvania, Massachusetts, New Mexico, Wisconsin, West Virginia, and Georgia are stalled. The Association of Public Health Laboratories has urged U.S. Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. to reinstate the personnel, warning that without the lab, "more people get sick, or you don't recognize outbreaks at all, and they just continue to spread unchecked."
San Francisco Considers "Recovery First" Approach to Combat Rising Overdose Deaths - San Francisco Supervisor Matt Dorsey has proposed a shift in the city's drug policy as overdose deaths climb back up after a promising drop last year. The "Recovery First" ordinance, which headed to committee on April 24th, aims to make cessation of illicit drug use and long-term recovery the primary objective of the city's drug policy. While the proposal has faced criticism from some harm reduction advocates, Dorsey clarified that it doesn't aim to eliminate harm reduction services such as needle exchange programs. Recent data from the Office of the Medical Examiner shows an average of 64 overdose deaths per month over the past three months in San Francisco, coinciding with decreasing prices of fentanyl, which can now cost as little as $2 for a four-hour high.
Study Finds Harm Reduction Policies Increase Trust in Local Government - A new study by researchers at the University of Pennsylvania's Annenberg Public Policy Center and Social Action Lab challenges common assumptions about harm reduction approaches to substance use. The research, published in the Harm Reduction Journal, examined communities in rural Appalachian and Midwestern counties vulnerable to HIV and hepatitis C spread. Contrary to fears that implementing harm reduction measures might erode public trust, researchers found that comprehensive drug policies that include harm reduction interventions are positively associated with increased confidence in local government. Lead author Xi Liu noted, "Despite concerns that harm reduction policies might inadvertently promote drug use, residents trust local authorities more when the authorities promote these policies," suggesting that policymakers' hesitation to implement such approaches due to feared backlash may be unwarranted.
HHS Secretary RFK Jr. Headlines Major Drug Policy Summit Amid Controversy - U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. was announced as a surprise closing plenary speaker at the 14th annual Rx and Illicit Drug Summit in Nashville on April 24th. The announcement has raised concerns among some public health experts, given Kennedy's controversial proposals regarding substance use, including his advocacy for "healing farms" where people facing drug charges would be sent to "learn the discipline of hard work." The summit, which charges over $1,000 for registration, also featured speakers including Attorney General Pam Bondi and Senator Marsha Blackburn, who reportedly focused heavily on border security as a solution to drug issues. Critics worry about the direction of federal drug policy as agencies like the Substance Abuse and Mental Health Services Administration undergo significant restructuring under the current administration.
California Becomes First State to Offer Generic Narcan Through State-Run Program - Governor Gavin Newsom announced on April 22nd that California has become the first state to offer a generic version of the overdose-reversal drug Narcan (naloxone) for public purchase through a state-run storefront. The CalRx program aims to make the life-saving medication more affordable and accessible to all Californians, not just "the privileged few." This initiative comes nearly a year after California began selling over-the-counter naloxone nasal spray to businesses and government groups. The program exists alongside the state's broader harm reduction efforts, including the California Harm Reduction Initiative (CHRI), which works to reduce overdoses by distributing syringes and fentanyl test strips. Critics have pointed to what they see as contradictions in the state's approach to drug policy, which includes both overdose prevention and supervised consumption services authorized in select cities.