Adap shortfall relief - puerto rico is a U.S. Commonwealth with a territory of approximately 4,000 square miles and an estimated population of 3,203,295 (u. S. Census, december 2024)

The Health Resources and Services Administration awarded the Puerto Rico Department of Health $3.43 million on April 1, 2026, under the HIV Care Formula Grants program (CFDA 93.917) to purchase antiretroviral medications for eligible people with HIV through the Puerto Rico AIDS Drug Assistance Program (PR-ADAP). The award funds medication acquisition for 286 newly eligible people with HIV living in Puerto Rico, addressing a drug formulary limitation that has constrained the program's capacity to serve eligible consumers. As of March 31, 2025, PR-ADAP had provided medications to 7,512 eligible consumers through contracted provider networks; this relief funding targets the gap created by Puerto Rico's fiscal environment and Medicaid financing uncertainties. The drug acquisition will be conducted through a wholesaler vendor contracted by PR-ADAP. The period of performance runs from April 1, 2026, through March 31, 2027, with place of performance in San Juan, Puerto Rico. The HIV Care Formula Grants program assists states and territories in developing and enhancing access to comprehensive high-quality HIV care and treatment for low-income people with HIV. ADAP Emergency Relief Funds awards are distributed via formula based on a competitive application process with need-based criteria. The Puerto Rico Department of Health is a territorial health agency that administers Medicaid, CHIP, and multiple federal grant programs across health surveillance, vital statistics, drinking water infrastructure, and HIV/AIDS services.

The island is comprised of 78 municipalities, grouped for purposes of public health services, into eight health regions: aguadilla, arecibo, bayamon, caguas, fajardo, mayaguez, ponce, and SAN juan. According to the 2024 u.s census an estimate of 224,038 persons in PR does not have health insurance. Of this number, 1,152 are likely to be pwha. As of december 31, 2024, a total of 16,769 persons were living with diagnosed HIV infection (pwha), 75% percent of pwha were =45 years; heterosexuals accounted for the largest proportion of pwha followed by men who have SEX with men (MSM), 36.1% and 34.1%, respectively. Persons who inject drugs (pwid) accounts for 22.4% of prevalent cases. In 2022, 59.0% of the newly reported diagnoses in PR were attributed to unprotected SEX among MSM, followed by 30.1% unprotected heterosexual contact and 2.8% for pwid. According to CDC's latest report, PR is the nation's 18TH jurisdictions with the highest HIV diagnosis rate (13.5 per 100,000 population) and ranked 8TH as one of the jurisdictions with the highest HIV prevalence rate among adults and adolescents = 13 years (534.5 per 100,000 population) in 2023. From 2023 to 2024 the population newly diagnosed with HIV (including aids) in PR decreased by 10%. Up through march 31, 2025, the PR-adap provided medications to 7,512 eligible consumers through the adap providers' network. The only PR-adap limitation is a restricted drug formulary. If granted, FY 2026 ERF funds are going to be used to purchase much needed HIV drugs to meet medication needs for 286 new eligible pwha living in PR. This adap drug acquisition will be conducted through a drug wholesaler vendor contracted by the adap. Puerto rico's fiscal and health environment, combined with medicaid financing uncertainties, the loss of adap program income and reduction in available resources to fund the adap, create an urgent need for FY 2026 ERF assistance. Without ERF support, puerto rico adap projects a $23,000,000 funding shortfall in FY 2026. The requested $7,000,000 million will: 1) prevent the establishment of cost cutting measures like decrease in financial eligibility criteria, enrollment cap for eligible patients, drug specific enrollment caps for arvs, among others, potential treatment interruption for over 1,200 current clients receiving drug assistance and the creation of a waiting list; 2) maintain alignment with the EHE national strategic plan; 3) uphold hrsa HAB priorities for equitable access; and 4) sustain program operations through policy transition. ERF funding is essential to ensure uninterrupted medication access, preserve viral suppression, and protect the health gains achieved among people with HIV in puerto rico.