Yeztugo vs. Apretude: Cost, Switching, and Which Injectable PrEP to Choose
Two injectable PrEP options are now available in the U.S. — Yeztugo (lenacapavir, every 6 months) and Apretude (cabotegravir, every 2 months). Both can be obtained at $0. Here's how they compare and how to choose between them.
Side-by-Side Comparison
| Yeztugo (lenacapavir) | Apretude (cabotegravir) | |
|---|---|---|
| Manufacturer | Gilead Sciences | ViiV Healthcare (GSK) |
| FDA approved | June 2025 | December 2021 |
| Dosing schedule | Every 6 months | Every 2 months |
| Injection type | Subcutaneous (under the skin) | Intramuscular (into muscle) |
| Loading phase | Oral pills + 2 injections at start | 2 injections one month apart |
| Efficacy | 96–100% (PURPOSE trials) | 69% more effective than oral PrEP (HPTN 083/084) |
| Annual list price | ~$28,218 | ~$24,000–$33,000 |
| Copay program (insured) | Up to $8,000/yr + $100/visit | Up to $7,850/yr |
| Free for uninsured? | Yes (Gilead MAP, <500% FPL) | Yes (ViiVConnect, <500% FPL) |
| SSN required? | No | Contact ViiV to confirm |
| Clinic visits/year | 2 (after loading) | 6–7 |
| Drug class | Capsid inhibitor | Integrase inhibitor |
| Approved populations | All adults & adolescents (≥77 lbs) | All adults & adolescents (≥77 lbs) |
Yeztugo Out-of-Pocket Cost
Yeztugo's annual list price is approximately $28,218 (~$14,109 per injection). That number is largely irrelevant for most people, because Gilead's assistance programs cover it.
With private insurance: The ACA requires most plans to cover PrEP at $0, though some insurers have been slow to add Yeztugo specifically. As of early 2026, Gilead estimates approximately 75% of U.S. insurers cover Yeztugo, with 90% expected by mid-2026. If your plan has a copay, Gilead's Advancing Access copay savings program covers up to $8,000/year plus $100 per injection visit for administration costs, reducing your out-of-pocket to $0.
Without insurance: Gilead's Medication Assistance Program (MAP) provides Yeztugo free to uninsured patients with household income below 500% FPL (~$75,300/year for an individual). No Social Security number is required — undocumented residents are explicitly eligible. Medication can ship overnight via FedEx to a home, clinic, shelter, or FedEx location.
CVS Caremark Coverage Note
CVS Caremark, the second-largest pharmacy benefit manager in the U.S., initially declined to add Yeztugo to its commercial drug plans. If your insurance runs through CVS Caremark, check with your plan directly or ask your provider to pursue prior authorization. Gilead's MAP can serve as a backstop for patients whose insurers refuse coverage.
Apretude Out-of-Pocket Cost
Apretude costs approximately $4,038–$5,460 per injection at retail, with an annual total of $24,000–$33,000 for 6–7 injections per year. Again, the list price is mostly theoretical.
With private insurance: Covered at $0 under the ACA. If there's any remaining copay, ViiV's Apretude Savings Program covers up to $7,850/year.
Without insurance: ViiVConnect provides Apretude free to qualifying uninsured patients (income below 500% FPL). Call 1-844-588-3288.
For the full breakdown, see our Apretude cost guide.
Can You Switch from Apretude to Yeztugo?
Yes, you can switch. Many people currently on Apretude are interested in moving to Yeztugo for the convenience of fewer clinic visits (2 per year instead of 6–7). Here's what the transition involves:
What to expect when switching
Talk to your provider first. Switching between injectable PrEP medications should always be managed by your healthcare provider. The two drugs use completely different mechanisms (Apretude is an integrase inhibitor; Yeztugo is a capsid inhibitor), so this isn't a simple brand swap.
Yeztugo has its own loading phase. When starting Yeztugo, you take oral lenacapavir pills on day 1, then receive two subcutaneous injections — also on day 1 — followed by your first maintenance injection at month 7. Your provider will coordinate the timing to ensure continuous HIV protection during the transition.
No formal "waiting period" is required. There's no clinical reason you must wait a specific amount of time after your last Apretude injection before starting Yeztugo. However, your provider will want to ensure your HIV test is current (required before initiating any PrEP) and that the timing makes sense for your care schedule. Cabotegravir (Apretude) has a very long pharmacological "tail" — the drug remains in your system for many months after your last injection — so there's no urgency about a coverage gap.
Insurance transition. You'll need to switch from ViiV's assistance programs to Gilead's. Your provider or specialty pharmacy can help enroll you in Gilead Advancing Access before your first Yeztugo dose.
Can you switch from Yeztugo to Apretude?
Yes, the reverse switch is also possible. However, since Yeztugo only requires injections every 6 months, switching to Apretude's every-2-month schedule would be less common. A provider might recommend it if you experience side effects with lenacapavir or have other clinical reasons to switch. The same principle applies — work with your provider and ensure continuous coverage.
Which One Should You Choose?
Both drugs prevent HIV extremely effectively and both can be obtained at $0. The decision comes down to practical factors in your life.
Choose Yeztugo if you...
- Want the fewest clinic visits possible (2/year after loading)
- Travel frequently or have an unpredictable schedule
- Struggle with appointment adherence — fewer visits means fewer chances to fall off
- Want the highest demonstrated efficacy (zero infections in the PURPOSE 1 trial)
- Are uninsured and undocumented — Gilead MAP explicitly doesn't require SSN
- Prefer a subcutaneous injection (under the skin, generally less painful than intramuscular)
Choose Apretude if you...
- Prefer a drug with a longer track record (FDA approved 2021 vs. 2025)
- Have regular access to a provider and don't mind bimonthly visits
- Your insurer hasn't yet added Yeztugo to its formulary
- Want more frequent check-ins with your provider as part of your care
- Are already stable on Apretude with no issues — switching isn't always necessary
Important for trans women and people assigned female at birth
Descovy (the most common oral PrEP besides generic TDF/FTC) is not approved for people at risk through vaginal sex who were assigned female at birth. Both Yeztugo and Apretude are approved for all adults regardless of sex assigned at birth — making injectable PrEP particularly valuable for these populations.
Efficacy: How Do They Compare?
Yeztugo (PURPOSE trials): In PURPOSE 1, there were zero HIV infections among participants receiving lenacapavir — a 100% risk reduction compared to the background incidence rate. In PURPOSE 2, which studied a diverse population including cisgender men who have sex with men, transgender people, and nonbinary individuals, there were just 2 infections — a 96% risk reduction. These are the strongest PrEP trial results ever recorded.
Apretude (HPTN 083/084): In clinical trials, injectable cabotegravir was 69% more effective than daily oral TDF/FTC at preventing HIV. This was largely attributed to better adherence — an injection you receive at a clinic eliminates the daily pill adherence challenge.
Both drugs are highly effective. Yeztugo's trial data is more striking on paper, though the trials used different designs and comparison groups, making direct head-to-head claims difficult. No trial has directly compared the two injectables against each other.
Insurance Coverage Status
Apretude has been on the market since 2022 and has broad insurance coverage across commercial plans, Medicaid, and Medicare Part D.
Yeztugo is newer (approved June 2025) and insurance coverage is still expanding. Gilead reported that approximately 75% of U.S. insurers covered Yeztugo by the end of 2025, with a target of 90% by mid-2026. Under the ACA, insurers must cover FDA-approved PrEP at $0, though plans are not yet formally required to cover Yeztugo specifically without cost-sharing under current USPSTF guidance — they must, however, have an exceptions process if a provider determines the currently-covered options are medically inappropriate.
If your insurer hasn't added Yeztugo yet, your options are: (1) have your provider pursue prior authorization, (2) use the ACA exceptions process if oral PrEP isn't appropriate for you, or (3) enroll in Gilead's MAP if you meet income criteria.
Still deciding? Oral PrEP is always an option.
If you're not ready for injectable PrEP, daily oral PrEP (generic TDF/FTC or Descovy) is free through MISTR — consultation, labs, and medication delivery at $0 in all 50 states.
Start Free PrEP with MISTR →Use referral code ANDR735 at signup. Using this code helps keep FreePrEP.org running and supports free PrEP access for everyone.