CVS Health criticised for refusing coverage of one-of-a-kind HIV prevention drug Yeztugo
"The largest pharmacy benefit manager in the country, is shamefully blocking people from taking it," says Carl Schmid, HIV specialist on CVS unwilling to retail Yeztugo
By Aaron Sugg
CVS Health has refused to cover Gilead’s newly FDA-approved HIV prevention drug, Yeztugo (lenacapavir).
The medication is perscribed as a twice-yearly injection given every 6 months, which has been shown in clinical trials to be nearly 100% effective in preventing HIV.
A CVS spokesperson David Whitrap told Reuters that clinical, financial and regulatory factors informed the decision, noting the drug’s high cost – costing over $28,000.
“The entire world is excited by this drug and its potential” – Carl Schmid, HIV specialist, on the Yeztugo drug
Gilead said it is continuing price discussions with CVS and expects that 75% of US insurers will cover Yeztugo by the end of this year, with coverage rising to 90% by June 2026.
Although FDA-approved in 2025, lenacapavir’s development began nearly 20 years ago, making it the only injectable HIV prevention option currently available.
As one of the largest pharmacy benefit managers in the US, advocates are urging CVS to reconsider its decision and are calling on federal and state regulators to ensure compliance with existing PrEP coverage requirements.
Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, called the decision “shamefully blocking people from accessing a drug that could prevent HIV.”
“A drug will only work if people can access it” – Schmid on CVS Health refusing to cover the HIV drug
In a statement entitled, Clear Violation of Affordable Care Act Preventive Services Requirement, he wrote: “The entire world is excited by this drug and its potential contribution to preventing and eventually ending HIV.”
The HIV specialist continued: “However, a drug will only work if people can access it and right now CVS Health, which owns the largest pharmacy benefit manager in the country, is shamefully blocking people from taking it, unlike other payers.”
This comes months after the Trump administration has ruled The National Institutes of Health (NIH) to terminate at least 145 grants related to researching advancements in HIV care.
Schmid, in a statement issued in June of this year called for action: “We urgently call on Congress to reject these cuts in order to ensure that states and community-based organisations have the resources to prevent HIV, which is still a serious infectious disease and results in about 32,000 new cases each year.”