CVS Health, the largest pharmacy benefit manager in the United States, will not cover Gilead Sciences’ Yeztugo, for now. Yeztugo, whose generic name is Lenacapavir, will not be carried through its commercial plans, nor the Affordable Care Act, since CVS’s Affordable Care Act program follows recommendations and mandates from the U.S. Department of Health and Human Services (HHS).
CVS based the decision on “clinical, financial, and regulatory factors,” a CVS spokesperson said in an email. Gilead Sciences is still currently negotiating the price of Yeztugo with CVS, which is currently priced at over $28,000 annually. A few Medicare, VA, and select Medicaid plans are already covering the drug.
Gilead Sciences, its investors, as well as AIDS activists, have high hopes for the breakthrough drug. Approved in June for people at high risk of HIV, the drug was shown to be nearly 100% effective at preventing infection in large trials, renewing hope about controlling the spread of the deadly virus. Cisgender men and women were among the patient trials, as well as transgender and nonbinary individuals.
“CVS Health’s decision is a clear violation of the ACA’s requirement to cover USPSTF-recommended preventive services, including PrEP,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, says in a statement. “The entire world is excited by this drug and its potential contribution to preventing and eventually ending HIV. 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. We urge CVS, which has been committed to ending HIV in the past, to reconsider their decision immediately.”
