The company is also navigating activist criticism over access to Yeztugo and ongoing negotiations with Gilead, even as U.S. government programs and some state Medicaid plans have already added the drug to coverage lists.
CVS Health, which operates the largest U.S. pharmacy benefit manager, will not add Gilead Sciences’ new HIV prevention drug Yeztugo to its commercial or Affordable Care Act (ACA) plans for now.
The decision was based on clinical, financial, and regulatory factors, according to a Reuters report. The company added that its ACA preventive program follows recommendations from the U.S. Department of Health and Human Services (HHS).
Current HIV prevention guidelines from the U.S. Preventive Services Task Force, supported by HHS, only include three older drugs: generic Truvada, Gilead’s Descovy, and ViiV Healthcare’s Apretude.
Yeztugo, a twice-yearly injection with a U.S. list price of more than $28,000, was approved in June and shown in large trials to be nearly 100% effective at preventing HIV infection.
CVS and Gilead reportedly remain in negotiations.
AIDS advocates criticized CVS’s position, calling it a missed opportunity given Yeztugo’s potential to transform HIV prevention. Mitchell Warren, executive director of AVAC, said the decision reflects unsustainable drug pricing in the U.S.
Gilead said it is encouraged by its payer discussions and expects 75% of U.S. insurers to cover Yeztugo by the end of 2025 and 90% by mid-2026.
U.S. government programs including the Veterans Administration and Medicare have already added the drug, while several state Medicaid plans, including California and New York, are covering it.
UnitedHealth Group’s OptumRx said it will assess Yeztugo in the coming weeks.
CVS Caremark, OptumRx, and Express Scripts together control about 70% of specialty drug prescriptions in the United States.
In a separate setback, a federal judge ordered CVS Health’s Caremark unit to pay nearly $290 million in a Medicare fraud case.
The court found that Caremark caused false information to be submitted to Medicare, and in a June 25 opinion, concluded that the company’s actions led to 513 false reports being filed in 2013 and 2014.
Based on those findings, the judge tripled damages to $285 million and added $4.9 million in penalties, bringing the total judgment to $289.9 million.
On Stocktwits, retail sentiment for CVS Health was ‘bullish’ amid ‘normal’ message volume.
CVS Health’s stock has risen 63.2% so far in 2025.
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