HIV PrEP shot Yeztugo slowly overcomes cost hurdles

After initial insurer resistance over its roughly $30,000 annual list price, the twice-yearly PrEP injection Yeztugo is now reported to be covered by more than 85% of U.S. insurers, though some payers still exclude it.

The FDA approved the twice-yearly HIV pre-exposure prophylaxis (PrEP) injection Yeztugo (lenacapavir) last year, but its high list price slowed insurer uptake. Insurers and pharmacy benefit managers debated coverage through the fall. In recent months more payers have added Yeztugo to formularies, and a Gilead spokesperson said the drug is now covered by over 85% of U.S. insurers. Advocates and policy groups continue to emphasize remaining barriers to patient access. Key facts: - The FDA approved Yeztugo (lenacapavir) for HIV PrEP in June, and it is manufactured by Gilead Sciences. - Yeztugo’s list price is reported at nearly $30,000 annually, higher than some existing PrEP options. - CVS Caremark initially did not cover Yeztugo but added it to its standard commercial formularies effective Jan. 1, according to statements cited in the article. - Some large PBMs have added the drug earlier, while others, including Optum, have kept it off certain formularies citing higher net cost. - Medicaid and ACA marketplace plans are reported to cover the injectable PrEP option. Summary: Insurer coverage for the twice-yearly PrEP injection has expanded since initial resistance tied to its high list price, and the article reports broadening formulary placement across major payers. Undetermined at this time.