“Up to this point,” [Kenyon Farrow] says, “there was a perverse incentive for drug prices to be high,” because 340B and drugmaker charity programs like Gilead ensured a high retail payback rate to clinics that they could use to fund visits and labs for the uninsured. “But now,” he says, “we have low-priced generics in the HIV meds market for the first time, so we’ve reached a crisis. We’re going to have to think about what direction we want to advocate for. Getting Medicaid expansion in those holdout states, which also have high HIV rates and low PrEP uptake? That would alleviate a lot of uncompensated costs,” he says, because Medicaid would then cover visits and labs.