CVS Health is refusing to provide coverage for groundbreaking HIV prevention drug, lenacapavir, claiming it’s too expensive. Though the producing drug company, Gilead, claims to still be negotiating the price with CVS, the pharmacy benefit manager claims it will not provide coverage through commercial plans nor the Affordable Care Act, according to reports from Advocate.
David Whitrap, a CVS spokesperson, told Reuters that the decision was based on “clinical, financial and regulatory factors.”
Despite this, lenacapavir, also known generically as Yeztugo, has been proven nearly 100 percent effective. Advocate reports the cost of the drug for CVS would be around $28,000 annually, but projections from UNAIDS and The Lancet HIV have indicated that those needing the drug might only have to pay $35-46 per person/year.
Gilead reports it has not had issues striking up a deal with other pharmacy benefit managers, and that it is still gunning to reach 75% insurer coverage by the end of 2025, and 90% by June of 2026.
UNAIDS indicates that as of 2024, 40.8 million people were living with HIV globally, and 1.3 million people contracted the virus.
In June, injectable lenacapavir was approved by the Food and Drug Administration (FDA) for use as a PrEP. The injection can be administered for prevention just twice a year, and is the first and only HIV prevention drug available for use today.
“CVS Health’s decision is a clear violation of the ACA’s requirement to cover USPSTF-recommended preventative service, including PrEP,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.
“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, unlike other payers.”
Pharmacy benefit managers (PBMs) act as liaisons between drug companies, pharmacies and consumers. CVS is the largest provider of this kind after merging with Aetna and Caremark.
“We urge CVS, which has been committed to ending HIV in the past, to reconsider their decision immediately,” Schmid said. “Additionally, we call on federal and state regulators to ensure that plans are in compliance with the federal government’s PrEP coverage guidance and the many state laws that require coverage of all PrEP drugs.”
