CVS Health, the nation's largest pharmacy benefit manager, will not cover Gilead's HIV-prevention drug lenacapavir (Yeztugo) under its commercial plans or the Affordable Care Act, citing clinical, financial, and regulatory factors and the drug's high cost, reported at over $28,000 annually. Gilead is negotiating price and expects expanding insurer coverage. Advocates say the move violates ACA requirements to cover USPSTF-recommended preventive services and blocks access. Yeztugo received FDA approval for prevention in June after trials showed a 96 percent relative risk reduction, and is administered as a clinic injection every six months.
CVS Health's decision is a clear violation of the ACA's requirement to cover USPSTF-recommended preventive services, including PrEP. 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.
The decision was based on "clinical, financial, and regulatory factors."
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