Yeztugo (lenacapavir) is a twice-yearly injectable PrEP approved by the FDA in June 2025. In clinical trials, 99.9% of participants remained HIV-negative. It was named Science magazine's 2024 Breakthrough of the Year. And yes — it can be free through Gilead's assistance programs.
Not two pills a day. Not two shots a month. Two injections. Per year.
That's the dosing schedule for Yeztugo (lenacapavir), the first twice-yearly injectable PrEP, approved by the FDA on June 18, 2025. And the clinical trial results weren't just good — they were historic.
In the PURPOSE 1 trial involving 5,300 cisgender women in South Africa and Uganda, not a single participant who received lenacapavir contracted HIV. Zero. In the PURPOSE 2 trial — 3,200 cisgender men, transgender men, transgender women, and gender non-binary individuals across seven countries — efficacy was 96%. Combined across all populations, the drug achieved what no HIV prevention tool has before: near-perfect protection with the least possible burden on the patient.
Science magazine called it their 2024 Breakthrough of the Year, describing it as "a pivotal step toward diminishing HIV/AIDS as a global health crisis."
How It Works
Lenacapavir is what's called a capsid inhibitor — the first in an entirely new class of antiretroviral drugs. It targets the protein shell surrounding HIV's genetic material, preventing the virus from assembling and replicating. Because the drug binds so tightly and is released so slowly from the injection site, two subcutaneous injections per year maintain protective drug levels continuously.
Compare that to the current options:
- Daily oral PrEP (Truvada/Descovy): One pill every day. Effective but adherence-dependent — miss a few days and protection drops.
- Apretude (cabotegravir injectable): One injection every two months after an initial loading period. Much better than daily pills, but still six visits per year.
- Yeztugo (lenacapavir): Two injections per year. Period.
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Why This Matters Beyond Convenience
This isn't just about making life easier (though it does). The biggest driver of PrEP failure is adherence — people stop taking their daily pills. Life gets in the way. Stigma makes it uncomfortable to keep medication visible. Travel disrupts routines. Some people simply don't want a daily reminder of risk.
With twice-yearly dosing, adherence essentially becomes a non-issue. You show up twice a year, get an injection, and you're protected. No pills to remember, no bottles to hide, no prescriptions to refill.
For populations that face the highest barriers to daily medication — young people, people experiencing housing instability, those in rural areas far from pharmacies — this could fundamentally change the math on HIV prevention.
Can You Get It for Free?
Yes. Yeztugo is covered by Gilead's Advancing Access Patient Assistance Program under the same terms as Truvada and Descovy: free medication for uninsured individuals at or below 500% of the Federal Poverty Level (roughly $60,300/year). No immigration status requirement. Call 1-800-226-2056.
For those with private insurance, the ACA mandate (preserved by the Supreme Court's June 2025 ruling in Kennedy v. Braidwood Management) requires $0 cost-sharing for all FDA-approved PrEP medications — including injectable options. If your insurer is charging you, they're violating federal law.
Gilead's Co-Pay Coupon program also covers up to $7,200/year for commercially insured patients who face copays despite the mandate.
Ready to switch to injectable PrEP?
Talk to a MISTR provider about whether Yeztugo or Apretude is right for you. Free consultation, no clinic visit required.
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The Global Picture
The WHO granted lenacapavir prequalification in October 2025, clearing the way for distribution in lower-income countries. Generic development is expected by 2027 at an estimated cost of $40 per person per year — down from a U.S. list price of thousands. If generics deliver on that promise, twice-yearly PrEP could be the tool that finally bends the global HIV epidemic toward zero.
In the U.S., the challenge isn't the drug — it's awareness. Most Americans have never heard of lenacapavir, Yeztugo, or twice-yearly PrEP. That needs to change.
Learn more about injectable PrEP options: FreePrEP.org Injectable PrEP Guide →
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Whether you prefer daily pills or twice-yearly injections, MISTR provides free PrEP in all 50 states. No insurance required.
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Frequently Asked Questions
How often do you need Yeztugo injections?
Twice per year — one injection every six months, given as a subcutaneous (under-the-skin) injection. The first injection is followed by a second one month later, then every six months after that.
Is Yeztugo really free?
It can be. Gilead's Advancing Access program provides Yeztugo free to uninsured individuals earning under roughly $60,300/year. Private insurance must also cover it at $0 under the ACA preventive services mandate.
What's the difference between Yeztugo and Apretude?
Both are injectable PrEP, but Yeztugo (lenacapavir) is given twice per year while Apretude (cabotegravir) is given every two months. They work through different mechanisms — lenacapavir is a capsid inhibitor and cabotegravir is an integrase inhibitor.