Since its introduction in June, Yeztugo - Gilead Sciences’ long-acting injectable for HIV pre-exposure prophylaxis - has registered growing but uneven uptake, according to discussions with clinicians, a telehealth provider and AIDS activists. While regulatory reviews found the drug nearly 100 percent effective at preventing HIV infection in at-risk adults and adolescents, real-world adoption has been constrained by both patient choices and the structure of insurance benefits.
Prescribing data collected by IQVIA show more than 9,000 prescriptions for Yeztugo were written in the first quarter of this year. That compares with roughly 461,000 prescriptions for Gilead’s oral PrEP Descovy, about 32,000 for Viiv Healthcare’s Apretude injection, and approximately 4,400 for Truvada in the same period. Despite the arrival of Yeztugo, the overall weekly number of PrEP prescriptions has not climbed, the data provider found.
Provider experience and patient interest
At the Montefiore AIDS Center in New York, medical director Dr. Barry Zingman said the clinic has ‘‘close to 75 people who are on Yeztugo right now, which is not as many as we expected or hoped,’’ out of around 700 patients on PrEP medication. Zingman noted that many of Montefiore’s patients continue with daily Descovy or low-cost generic Truvada, treatments that clinical studies have found effective when taken as directed or used on demand.
Clinicians also described distinct patient preferences. Some individuals favor the convenience of a daily pill, while others are reluctant to have a drug remain in their bodies for extended periods. Zingman summarized that for ‘‘a fair number of people’’ the daily pill model ‘‘fits their lifestyle and their risk profile better.’’
Insurance design and cost barriers
Insurer benefit design is a primary obstacle to broader Yeztugo use. Gilead has said more than 90 percent of insurers cover Yeztugo, and the company has pointed to minimal out-of-pocket costs for most insured patients. Insurers and pharmacy benefit managers describe a different picture in practice: Yeztugo is frequently handled as a medical benefit rather than a pharmacy benefit. That treatment requires providers to acquire the dose and may subject patients to cost-sharing such as co-payments or deductibles.
The drug carries a U.S. list price of over $14,000 per dose for the twice-yearly injection. By contrast, the lowest-cost option, generic daily PrEP pills, amount to about $350 a year. These price differentials drive benefit design decisions. CVS Health, which operates the largest U.S. pharmacy benefit manager, said employer and union clients can set plan rules that favor clinically similar but less costly drugs. CVS added that talks with Gilead have ‘‘achieved a significant discount on Yeztugo,’’ while acknowledging the drug’s net price after discounts remains substantially higher than alternative PrEP options.
UnitedHealthcare, the country’s largest health insurer, told reporters that its commercial plans continue to cover older HIV prevention drugs at zero cost to patients. The insurer also noted that, because Yeztugo has not been added to a federal preventive care recommendation issued by the panel that guides free preventive services, plans may set patient cost-sharing individually. That 2023 panel recommendation endorses providing drugs to people at high risk to prevent HIV, but it has not been updated to include Yeztugo.
Clinic-level approaches and financial gaps
Some clinics have been proactive in securing access. Dr. Rachel Presti at Washington University’s HIV clinic in St. Louis said the clinic has seen ‘‘a lot of interest in Yeztugo,’’ and that it operates an onsite pharmacy that is experienced in seeking coverage. Still, she added, ‘‘if your insurance doesn’t cover a pharmacy benefit, we can’t give it.’’
Spectrum Medical Center in Phoenix reported a faster early shift. Medical director Dr. Howard Grossman said in early April that roughly 200 of the center’s more than 1,000 PrEP patients had switched to Yeztugo, and he expects those numbers to grow. As a nonprofit, Spectrum is charged a discounted per-dose price of $10,100, Grossman said. By contrast, UnitedHealthcare has reimbursed providers only $6,000 or $7,000 under some plans, according to Grossman. UnitedHealthcare declined to comment for this report. Patients who lack full coverage can receive assistance from Gilead or other patient support programs to help bridge gaps.
Distribution choices among telehealth providers
The expansion of telehealth for PrEP also affects Yeztugo’s reach. The Centers for Disease Control and Prevention estimates about 600,000 of the 2.2 million Americans who could benefit from PrEP are currently taking one of these medications. Many patients receive pills by mail from services that promote ‘‘no awkward doctor visits, no needles, no paperwork.’’ That model has been growing: a 2024 JAMA-published study found roughly 19 percent of U.S. PrEP prescriptions were filled by telehealth service MISTR, up from 2 percent in 2020.
MISTR operates seven U.S. storefronts where injections could be administered, but the company said it will not offer Yeztugo until enough insurers commit to reimbursing for pharmacy administration. Tristan Schukraft, MISTR’s CEO, said the company does not want to introduce the product and then see most patients denied coverage. ‘‘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,’’ he said.
Market forecasts and company financials
Analysts tracked by LSEG estimate Yeztugo sales could rise to more than $5 billion annually by 2032. Gilead has forecast 2026 sales of $800 million and is scheduled to report first-quarter results on Thursday. The company has expressed enthusiasm about uptake, reiterating that most insured patients face minimal out-of-pocket costs.
Patient concerns and advocates’ views
Advocates and clinicians highlighted a mix of optimism and caution. Michael Weinstein, president of the AIDS Healthcare Foundation, said Yeztugo ‘‘will be a game-changer for individuals who want to be on a drug permanently.’’ At the same time, Weinstein and others noted practical deterrents. Some patients dislike needles, while others are concerned about visible nodules that can form under the skin at the injection site. Those side effects, even if relatively uncommon or small, factor into individual decisions.
Outlook
Yeztugo’s trajectory to broader market penetration depends on multiple moving parts: whether insurers shift benefit design so the shot is covered without patient cost-sharing, whether telehealth and retail providers choose to provide in-office administration, and how patients weigh the convenience of infrequent injections against the familiarity and low price of daily pills. For now, providers say demand exists but is tempered by these structural and personal considerations.