A groundbreaking HIV prevention injection is slowly gaining ground among patients, though healthcare providers across the nation report significant barriers preventing wider adoption of the twice-yearly treatment.
Gilead Sciences’ Yeztugo, which launched in June, has seen growing prescription numbers, but medical professionals say insurance coverage problems and patient preferences are limiting its reach compared to traditional daily pill options.
Dr. Barry Zingman, who leads the Montefiore AIDS Center in New York, expressed mixed feelings about the uptake. “We have close to 75 people who are on Yeztugo right now, which is not as many as we expected or hoped,” Zingman noted. His facility treats approximately 700 patients with pre-exposure prophylaxis medications, known as PrEP.
Federal health officials gave their approval to Yeztugo for high-risk adults and teenagers after clinical trials demonstrated nearly perfect effectiveness in blocking HIV transmission. Other available options include Gilead’s daily Descovy pills, generic versions of the older medication Truvada, and Viiv Healthcare’s Apretude injection administered every two months.
Prescription tracking data from IQVIA shows more than 9,000 Yeztugo injections were prescribed during the first three months of 2024. This compares to roughly 461,000 Descovy prescriptions, 32,000 Apretude injections, and 4,400 Truvada prescriptions during the same period. Notably, total weekly PrEP prescriptions have remained flat.
Market researchers project Yeztugo revenue could exceed $5 billion annually by 2032, while Gilead has set a target of $800 million in sales for 2026. The pharmaceutical company expressed satisfaction with early adoption rates and emphasized that most insured patients face minimal personal costs.
Federal health data indicates roughly 600,000 of the 2.2 million Americans who would benefit from PrEP medication currently receive such treatment. Expanding access to those not yet protected while transitioning current patients to the new injection presents a substantial challenge, particularly as more individuals obtain pills through mail-order services advertising convenience without doctor visits or needles.
Telehealth provider MISTR filled approximately 19% of all U.S. PrEP prescriptions in 2024, a dramatic increase from just 2% in 2020, according to research published in JAMA medical journal.
Despite operating seven physical locations where Yeztugo could be administered, MISTR has chosen not to offer the injection until more insurance companies agree to cover pharmacy administration costs. “The last thing we want to do is introduce Yeztugo and then have 9 out of 10 people get rejected for it based on insurance,” explained MISTR CEO Tristan Schukraft.
While Gilead reports that over 90% of insurers provide Yeztugo coverage, the medication is frequently classified as a medical benefit rather than a pharmacy benefit. This classification requires healthcare providers to purchase the drug upfront and can subject patients to copayments or deductibles.
Each twice-yearly injection carries a U.S. list price exceeding $14,000, while generic daily pills cost approximately $350 annually, representing the most affordable prevention option.
Dr. Rachel Presti, who works at Washington University’s HIV clinic in St. Louis, reported significant patient interest in the new injection. Her facility operates an on-site pharmacy with expertise in securing drug coverage. However, she noted limitations: “If your insurance doesn’t cover a pharmacy benefit, we can’t give it.”
Most PrEP patients at Montefiore continue using daily Descovy pills or lower-cost generic Truvada, which research has proven effective when used as needed. “Many people just don’t want something in their body for weeks or months on end,” Zingman observed. “For a fair number of people that fits their lifestyle and their risk profile better.”
Dr. Howard Grossman, medical director at Spectrum Medical Center in Phoenix, reported that about 200 of their more than 1,000 PrEP patients had transitioned to Yeztugo by early April, with numbers expected to continue climbing.
As a nonprofit organization, Spectrum receives a reduced price of $10,100 per dose, Grossman said. However, UnitedHealthcare, the nation’s largest health insurer, reimburses providers only $6,000 to $7,000 under certain plans. UnitedHealthcare declined to provide comment on their reimbursement policies.
Qualified patients can access assistance through Gilead or other programs to help cover cost differences. Meanwhile, standardized coverage remains uncertain. The federal panel responsible for determining free preventive care access recommended in 2023 that high-risk individuals receive HIV prevention drugs, but this guidance has not been updated to include Yeztugo.
Consequently, patient expenses for Yeztugo vary by individual insurance plans, UnitedHealthcare confirmed via email, while noting that their commercial plans provide older HIV prevention medications at no cost to patients.
CVS Health, which operates the country’s largest pharmacy benefit manager, stated that employer and union clients can establish plan terms favoring clinically comparable but less expensive alternatives to Yeztugo. The company acknowledged achieving “a significant discount on Yeztugo” through negotiations with Gilead, though the discounted price remains substantially higher than other effective options.
Michael Weinstein, president of the AIDS Healthcare Foundation, predicted Yeztugo “will be a game-changer for individuals who want to be on a drug permanently.” However, he acknowledged that some patients dislike needles, while others worry about visible nodules that the slow-release medication can create under the skin.
“There is a lot of marketing muscle behind it, but it’s not a slam dunk,” Weinstein concluded.
