Virginia Department of Health and Gilead Settlement
VDH remains committed to the health, dignity and well-being of people living with HIV/AIDS in Virginia.
The Virginia Department of Health (VDH) and Gilead Sciences, Inc. have reached a settlement agreement to resolve an approximately $16.8 million overpayment to the Virginia Medication Assistance Program (VA MAP) for AIDS Drug Assistance (ADAP) rebates under the Ryan White Part B Program. Gilead is a biopharmaceutical company that manufactures antiviral drugs used to treat HIV.
VDH and Gilead determined that the overpayment resulted from a data mismatch involving ineligible rebate claims submitted between the second quarter of 2021 and the second quarter of 2023. In 2022, VA MAP transitioned to a new vendor and began submitting data to Gilead using a new nomenclature for identifying ineligible rebate claims. That nomenclature was not compatible with Gilead’s data format specifications, resulting in rebate overpayments. Through good faith discussions, VDH and Gilead agreed on the amount of overpayments, resolved the technical issues that caused it, and implemented measures to prevent similar instances in the future. VDH also is strengthening its quality assurance and quality improvement processes for program administration.
Under the settlement, VDH will reimburse Gilead through deductions from future rebates owed to VDH. No additional funding sources will be used for repayment. Importantly, VDH and Gilead structured the repayment terms to support the continued operation of the Ryan White Part B Program.
The reduced rebate revenue for the Ryan White Part B program necessitated cuts to the program including service providers, reductions or elimination of some services and programs, and staff reductions. Despite these challenges, VDH remains steadfast in its commitment to protecting the health, dignity and well-being of Virginians living with HIV. VDH has prioritized core medical services to ensure that eligible Virginians continue to have access to essential HIV care and medications. Patients remain covered and are receiving medications.
VDH is working closely with health care providers, community organizations and HIV advocates to strengthen and build a more resilient statewide infrastructure for Ryan White and HIV services. The department also is pursuing additional funding opportunities, including federal grants, to help sustain these critical services.
In addition, the General Assembly included more than $13 million over the next two fiscal years to help address the program’s funding gap and support continued access to HIV care for Virginians.