The two options available right now
There are exactly two injectable PrEP options available in U.S. pharmacies and clinics in 2026. Both are highly effective. The difference is how often you inject, how it's delivered, and what insurance treats it as.
FDA-approved June 18, 2025. Yeztugo is the first twice-yearly PrEP — two subcutaneous injections (in the belly fat) every six months, after oral loading doses. Clinical trials showed extraordinary efficacy: zero HIV infections in cisgender women in the PURPOSE 1 trial (100% risk reduction), and only two infections in the diverse PURPOSE 2 population (96% risk reduction). Science named lenacapavir the 2024 Breakthrough of the Year.
How to get it free: Gilead Advancing Access covers Yeztugo through its Medication Assistance Program (MAP) for uninsured patients under 500% FPL (~$60,300/year individual). No SSN is required and undocumented residents are explicitly eligible. Commercially insured patients can access up to $8,000/year in copay savings, plus $100 per visit toward injection administration.
Insurance status: CMS approved permanent J-codes effective October 1, 2025, so Medicaid and Medicare coverage is expanding. Commercial coverage is catching up — as of early 2026 some major PBMs still list Yeztugo off-formulary due to cost, so prior authorization is common. Telehealth platforms with 340B partnerships can fill gaps.
FDA-approved December 2021. Apretude is an intramuscular injection given every 2 months after an initial loading phase (two injections one month apart). In the HPTN 083 trial, Apretude was 69% more effective than daily oral PrEP at preventing HIV among cisgender men who have sex with men and transgender women — not because daily PrEP doesn't work, but because adherence to a pill is harder than showing up every two months.
How to get it free: The ViiVConnect Patient Assistance Program provides free Apretude to uninsured patients under 500% FPL. The APRETUDE Savings Program reduces commercially insured copays to as little as $0, with a savings cap of $7,850/year. ViiV also operates an Alternate Sites of Care (ASOC) network to help you find a provider that can actually administer the injection if your regular clinic can't.
Insurance status: Covered under most commercial, Medicaid, and Medicare plans, typically under the medical benefit (not pharmacy) because a clinician administers it. Prior authorization is common.
Side-by-side comparison
| Yeztugo (lenacapavir) | Apretude (cabotegravir) | |
|---|---|---|
| Schedule | Twice a year (every 6 months) | Every 2 months (6 times/year) |
| Injection type | Subcutaneous (belly fat) | Intramuscular (buttock) |
| Loading doses | Oral pills before first injection | Two injections one month apart, then every 2 months |
| List price | $28,218/year | ~$24,000/year ($4,038 per injection) |
| Copay assistance (insured) | Up to $8,000/year + $100/visit | Up to $7,850/year |
| Free for uninsured? | Yes — Gilead MAP (≤500% FPL, no SSN needed) | Yes — ViiVConnect PAP (≤500% FPL) |
| Approved in U.S. | June 2025 | December 2021 |
| FDA-approved for | Adults and adolescents ≥35 kg | Adults and adolescents ≥35 kg |
Trying to figure out which one's covered in your state?
MISTR handles the full process — medication, labs, consultations, and prior authorization paperwork — at $0 for insured and uninsured patients in all 50 states. Oral and injectable PrEP available.
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Start with MISTR →Which one is actually right for you
Choose Yeztugo if you want to inject as rarely as possible
Two visits a year is transformative for people who travel, work long hours, live far from a clinic, or just don't want to think about PrEP between visits. For anyone who's struggled with daily-pill adherence, this is a game-changer. The subcutaneous injection can also be administered by a broader range of clinicians than intramuscular cabotegravir, which may improve access long term.
Choose Apretude if it's available in your plan now
Apretude has four-plus years of real-world data, broader insurance formulary coverage (though this gap is closing as Yeztugo matures), and an established administration network. If your insurance covers Apretude today and coverage for Yeztugo is still being worked out, starting on Apretude now is reasonable — you can always switch to Yeztugo later.
Choose oral PrEP if daily pills aren't a problem for you
Daily oral PrEP (generic TDF/FTC or brand-name Descovy) is the most studied, most covered, and cheapest option. Generic TDF/FTC runs about $30/month cash and is on every Medicaid formulary in the country. If adherence to a daily pill isn't a barrier for you, oral PrEP is perfectly reasonable. Injectables shine mainly for people who struggle with daily pills or want the convenience of less frequent dosing.
Insurance rule to know
Under the ACA, preventive HIV services — including PrEP, the lab work that goes with it, and the clinical visits — are covered at $0 with no copay or deductible for most commercial plans. If your insurer is charging you for injectable PrEP, they may be billing it as treatment rather than prevention. Ask them to reprocess it as preventive care, cite USPSTF Grade A.
How to get injectable PrEP for $0, step by step
- Start with telehealth if you don't already have a prescriber. Platforms partnered with 340B-covered entities (FQHCs, Ryan White clinics) can provide PrEP at $0 whether you're insured or not. MISTR supports both oral and injectable PrEP and handles the paperwork.
- If you have commercial insurance: Ask your prescriber to submit for Apretude or Yeztugo. If you get a copay bill, enroll in the manufacturer's savings program — ViiVConnect for Apretude or Gilead Advancing Access for Yeztugo — before paying anything.
- If you have Medicaid: Both drugs are covered in most state formularies. Oral generic PrEP has no prior authorization; injectables often do. Your prescriber's office handles the PA.
- If you're uninsured and under 500% FPL: Apply directly to the manufacturer. Gilead Advancing Access ships Yeztugo free to your provider. ViiVConnect does the same for Apretude. Both programs are open to undocumented residents.
- If you live in a PrEP-DAP state (CA, CO, DC, IL, IN, IA, MA, NM, NY, OK, VA, WA): your state program may cover labs and injection administration fees that manufacturers don't. Check your state.
Don't know where to start? Use the eligibility tool.
Four questions, 60 seconds, no sign-up. We'll match you with every free PrEP program (oral or injectable) you qualify for.
Start the Eligibility Tool →What's in the pipeline
The injectable PrEP category is going to look very different in a few years. Here's what's coming.
Once-yearly lenacapavir
Gilead has a once-yearly formulation of lenacapavir in Phase III trials, with results expected in 2028. If efficacy holds, this would collapse the PrEP experience to a single annual visit — closer to a vaccine than a medication.
MK-8527 (islatravir): monthly oral
Merck's MK-8527 is in Phase III trials as a once-monthly oral pill for PrEP. It's not an injectable, but it's the most promising non-injectable long-acting option on the horizon and would fill a gap for people who don't want injections but can't take a daily pill.
Long-acting implants
Subcutaneous implants delivering PrEP for 6–12 months have reached Phase I/II trials. These aren't close to approval, but they represent where the field is going: minimal-contact, long-duration prevention that removes the burden of remembering to take or get anything at all.
Generic lenacapavir abroad
The Gates Foundation and Unitaid have arranged licensed generic production of lenacapavir at $40 per person per year for 120 low- and middle-income countries, starting in 2027. This won't directly affect U.S. pricing, but it's likely to exert downward pressure on the U.S. list price over time.
One thing to know about the "tail"
Injectable PrEP stays in your body much longer than oral PrEP. For Apretude, the drug can remain detectable for up to a year after your last injection — during that "tail" period, the drug is present but not at levels that prevent HIV. If you stop injectable PrEP, talk to your provider about bridging with oral PrEP. This is not a reason to avoid injectables — it's just a reason to plan your exit if you ever decide to stop.
Bottom line
Injectable PrEP in 2026 is genuinely a better option than daily pills for a lot of people — and the financial barriers that used to be a real obstacle have mostly dissolved. Both Apretude and Yeztugo are available at $0 through some combination of insurance, manufacturer assistance, and 340B telehealth, for both insured and uninsured patients. Yeztugo's twice-yearly schedule is the most significant change to PrEP since the first pill was approved, and the pipeline suggests the trend toward longer-acting options will continue.
If you're not sure which option makes sense for your situation — or whether you should stick with oral PrEP — use our eligibility tool or browse our state guides to see what's covered and available near you.
Ready to start injectable PrEP?
MISTR prescribes both Apretude and Yeztugo, coordinates lab work, and handles prior authorization at $0 for insured and uninsured patients in all 50 states.
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