Switching from Oral to Injectable PrEP: Timeline, Logistics & Cost

Tired of the daily pill? Ready to switch to an injection every two months (Apretude) or twice a year (Yeztugo)? Here's exactly how the transition works — the timeline, what to expect, how to make sure there's no gap in protection, and how to get injectable PrEP for $0.

Why switch?

The most common reasons people switch from oral to injectable PrEP:

• Adherence: Forgetting the daily pill is the #1 reason PrEP doesn't work at 99%. An injection eliminates the adherence problem entirely.
• Privacy: No pill bottle to explain. No daily routine to maintain.
• Convenience: 6 clinic visits per year (Apretude) or 2 per year (Yeztugo) vs. remembering a pill every day.
• GI side effects: Some people experience persistent nausea or GI issues with oral PrEP that resolve by switching to an injection.

Switching to Apretude (cabotegravir, every 2 months)

Step 1 — Oral lead-in (optional but recommended): Take oral cabotegravir (Vocabria) for about 4 weeks while continuing your current oral PrEP. This lets you test for any adverse reactions before committing to the long-acting injection. Some providers skip this step.

Step 2 — First injection: Get your first Apretude injection at your provider's office. You can stop oral PrEP at this point.

Step 3 — Second injection: Return one month after the first injection for the second dose.

Step 4 — Ongoing: Return every two months for subsequent injections. Each visit is about 15 minutes — injection plus brief check-in.

Protection timeline: You're protected continuously as long as you stay on schedule. If you're late for an injection by more than 7 days, contact your provider immediately.

Switching to Yeztugo (lenacapavir, twice yearly)

Step 1 — Oral lead-in: Take oral lenacapavir tablets for a brief period (your provider will specify the exact duration) while continuing your current oral PrEP. This establishes drug levels before the injection.

Step 2 — First injection: Get your first Yeztugo subcutaneous injection. You can stop oral PrEP.

Step 3 — Second injection: Return six months later for the second dose.

Step 4 — Ongoing: Two injections per year — that's it. Just two clinic visits annually for PrEP.

Cost: how to get injectable PrEP for $0

Apretude: List price ~$4,038 per injection (~$24,000/year). But almost nobody pays that. ViiVConnect's patient assistance program provides free Apretude for eligible uninsured patients. Most insurance covers it at $0 under the ACA. See our Apretude cost guide.

Yeztugo: List price ~$28,218/year. Gilead Advancing Access provides free Yeztugo for eligible uninsured patients under 500% FPL. Insurance coverage is expanding. See our Yeztugo cost guide.

Administration fees: The injection itself must be administered by a provider. Some clinics charge an administration fee. FQHCs, AHF locations, and ASOs typically include administration in their services. Ask about fees before scheduling.

Finding a provider who offers injectable PrEP

Not all PrEP providers offer injectables yet. LGBTQ+ health centers, academic medical centers, and larger FQHCs are most likely to have them. Ask your current provider if they administer Apretude or Yeztugo, or check our state-by-state guides for injectable-capable providers in your area.

MISTR can also help connect you with injectable PrEP providers in your area as part of their consultation.

What if I want to switch back to oral PrEP?

You can switch back to oral PrEP at any time. However, there's an important consideration: cabotegravir (Apretude) remains in your body for up to a year after your last injection, during which time the declining drug levels could theoretically allow HIV to develop resistance if you're exposed. Your provider should prescribe oral PrEP to cover this "tail" period. Discuss the transition plan with your provider before stopping injections.

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Frequently asked questions