42 U.S.C. § 300ff–26 — Provision of treatments

(a) In general. A state must use part of its section 300ff–21 grant to run a program (under section 300ff–22(b)(3)(B)) that provides drugs to treat HIV/AIDS or prevent serious health decline from it, including measures to prevent and treat opportunistic infections. (b) Eligible individual. To get help under this section, a person must: (1) have a medical diagnosis of HIV/AIDS; and (2) be low-income, as the state defines it. (c) State duties. The state must: (1) make sure it covers, at minimum, the drugs on the Secretary's list of core antiretroviral drug classes (subsection (e)); (2) pay for those drugs and for the devices needed to give them; (3) reach out to people with HIV/AIDS and, when appropriate, their families; (4) help people access these treatments; (5) track and document progress in getting the drugs to eligible people; and (6) encourage and support people in sticking to their treatment plans, including related medical monitoring. For that sixth duty, the state generally can't spend more than 5 percent of its section 300ff–26 money on it -- but that cap rises to 10 percent if the state shows the Secretary that the extra spending is essential and doesn't reduce access to the drugs themselves. (d) Duties of Secretary. The Secretary must review how state drug-reimbursement programs (under section 300ff–22(2)) are working and identify barriers to getting these drugs to more people. The Secretary must also check how well states coordinate with other grantees under this subchapter to reduce those barriers. (e) List of classes of core antiretroviral therapeutics. For subsection (c)(1), the Secretary must create and maintain a list of core antiretroviral drug classes, based on the drugs listed in the Secretary's Clinical Practice Guidelines for Use of HIV/AIDS Drugs. The Secretary can still update those Guidelines whenever needed. (f) Use of health insurance and plans. (1) Instead of buying drugs directly, a state may use its grant money to pay for people's health insurance or health plan costs, as long as that coverage includes a full range of the required drugs and appropriate primary care. (2) This option is only allowed if, for that year, the cost of the insurance or plan doesn't exceed what it would otherwise cost to provide the drugs directly. (g) Drug rebate program. Any drug rebates a state gets on drugs it bought with this section's money must go back into activities under this subpart, prioritizing activities under this section.