V.I. Seeks $1.8M to Cover HIV Drug Program Debt to Pharmacy Manager

Lawmakers in the U.S. Virgin Islands are being asked to approve $1.8 million to pay down a substantial debt run up by the territory's AIDS Drug Assistance Program to pharmacy benefits manager ScriptGuide RX.

Deputy Health Commissioner Renan Steele informed the Senate Committee on Health, Hospitals and Human Services on Tuesday that the Communicable Disease Division is working to resolve an outstanding balance of $1,889,502 owed to the vendor, with obligations tracing back to September 2025.

The shortfall has mounted as medication costs have climbed while insurance rebates have declined, according to Chief Medical Officer Dr. Tai Hunte Ceasar. The program now enrolls more uninsured residents, and reimbursements from insured participants are falling short of what is needed to cover treatment for those without coverage.

During the current year, the program has filled 2,567 prescriptions for 146 patients at a cost of approximately $3.81 million annually, with antiretroviral therapy representing roughly 99 percent of spending. Federal budget cuts and rising medication prices have further strained resources.

Dr. Hunte Ceasar assured lawmakers that enrolled patients continue to receive their HIV medications without interruption. "No Virgin Islander is at risk of not receiving HIV medications because we continue to utilize alternative funding sources and other pharmaceutical assistance programs," she said.

However, the debt threatens relationships with other vendors supplying laboratory testing and pharmaceutical support services that are integral to HIV care in the territory. The requested appropriation would allow the Department of Health to settle the ScriptGuide RX balance while maintaining these complementary services.

Dr. Hunte Ceasar rejected the notion that administrative failures caused the problem, noting instead that the debt accumulated rapidly within a single fiscal year rather than accumulating over time. "This is something that all jurisdictions have been facing in the nation," she told Senate President Milton Potter.

The federal AIDS Drug Assistance Program, part of the Ryan White HIV/AIDS Program, helps states and territories furnish medications to low-income people with HIV who lack adequate health insurance. Federal authorities have acknowledged that such programs can face sudden financial strain from declining rebates, loss of coverage, and growing patient numbers. Emergency relief funding exists but is awarded competitively; the territory is now seeking immediate support from the local Legislature.