The FDA approved Yeztugo, a 6-month biannual HIV PrEP injection, in June of last year. But health insurers were openly hesitant about covering the drug due to its annual cost of nearly $30,000.
By comparison, the other long-acting HIV PrEP injectable medication, Apretude, has an annual cost of roughly $22,000. Oral PrEP options are significantly cheaper, though adherence may be less strict as they are meant to be taken daily.
CVS Health became the face of this hesitancy when it said in August that it would not cover Yeztugo, citing financial and regulatory factors. Reporting at the time, however, suggested negotiations were still ongoing between CVS and Gilead, the manufacturer of Yeztugo.
Talks between the two companies appear to have been productive, with CVS walking back its decision earlier this month.
Other insurers are also agreeing to cover the drug, though not on all plans.
"We offer an oral generic and a long-acting injectable therapy option for the indication of HIV pre-exposure prophylaxis on both our premium and select formularies. Yeztugo's net cost was higher, so currently it is excluded on our premium formulary and on tier 3 of our select formulary," a spokesperson for Optum, one of the three largest pharmacy benefit managers in the country, said in a statement to The Hill.
The Blue Cross Blue Shield Association similarly said coverage will vary across different plans and companies under its umbrella.
"Each Blue Cross and Blue Shield health insurance provider is an independent company, making coverage decisions for specific medications based on state/federal requirements, clinical evidence, FDA approvals, and the needs of the members they serve," BCBSA said in a statement to The Hill.
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