Injectable PrEP is the biggest advance in HIV prevention since the original approval of oral PrEP in 2012. Instead of remembering a daily pill, you get an injection every 2 or 6 months — and clinical trials showed extraordinary efficacy, with one trial recording zero HIV infections.
Two injectable PrEP medications are now FDA-approved. Both can be obtained at zero cost through manufacturer patient assistance programs. Here's everything you need to know.
Yeztugo (Lenacapavir) — Every 6 Months
Yeztugo
Yeztugo is the first twice-yearly injectable PrEP — a subcutaneous injection every 6 months after initial oral loading doses. It was approved by the FDA on June 18, 2025, based on the landmark PURPOSE clinical trial program.
The results were historic. The PURPOSE 1 trial in cisgender women recorded zero HIV infections — 100% risk reduction. The PURPOSE 2 trial in a diverse population (men who have sex with men, transgender people, non-binary individuals) showed only 2 infections — a 96% risk reduction. These are the strongest efficacy results ever seen in a PrEP trial.
Yeztugo Cost & Assistance
Yeztugo's list price is approximately $28,218 per year. However, most patients should pay nothing:
- Private insurance: The ACA preventive services mandate requires $0 cost-sharing. CMS approved HCPCS J-codes effective October 1, 2025, enabling standard medical billing. If your plan charges a copay, Gilead's copay savings program covers up to $8,000/year plus $100/visit for injection administration.
- Uninsured (≤500% FPL): Gilead Advancing Access MAP provides Yeztugo completely free. No SSN required.
- Medicaid: Coverage varies by state. Prior authorization is common given oral alternatives exist.
- Medicare: Part B covers it as a medical benefit. Copay assistance through nonprofit funds (check Good Days Foundation).
Apply for Yeztugo Assistance
Call 1-800-226-2056 or apply online through Gilead Advancing Access. Uninsured patients under 500% FPL get free medication. Commercially insured patients get up to $8,000/year in copay coverage.
Apply at Advancing AccessHow Yeztugo Works
Yeztugo uses a novel mechanism — it's a capsid inhibitor that interferes with multiple stages of the HIV lifecycle. The dosing schedule starts with oral loading doses, followed by a subcutaneous injection at the start of month 1, then every 6 months thereafter. The injection is administered by a healthcare provider — it takes a few minutes and is given just under the skin (not into muscle).
Coming next: A once-yearly lenacapavir formulation is currently in Phase III trials, with results expected around 2028. This could further simplify PrEP to a single annual injection.
Apretude (Cabotegravir) — Every 2 Months
Apretude
Apretude was the first injectable PrEP approved by the FDA (December 2021). It requires an intramuscular injection every 2 months after an initial loading phase of two injections one month apart. In clinical trials, it was 69% more effective than daily oral TDF/FTC at preventing HIV.
List price is approximately $4,038 per injection (~$24,000/year). It's covered under most commercial, Medicaid, and Medicare plans as a medical benefit, though insurers frequently require prior authorization.
Apretude Cost & Assistance
- Private insurance: ACA mandate applies. ViiV offers a $0 copay savings card for commercially insured patients.
- Uninsured (≤500% FPL): ViiVConnect Patient Assistance Program provides Apretude completely free.
- Medicaid/Medicare: Generally covered under the medical benefit. Prior authorization common.
ViiV also maintains an Alternate Sites of Care (ASOC) network to help patients find injection providers in their area.
Apply for Apretude Assistance
ViiVConnect provides free Apretude to uninsured patients under 500% FPL and $0 copay savings for commercially insured patients.
Apply at ViiVConnectYeztugo vs. Apretude vs. Daily Pill
| Yeztugo | Apretude | Daily Oral PrEP | |
|---|---|---|---|
| Frequency | Every 6 months | Every 2 months | Daily |
| Administration | Subcutaneous injection | Intramuscular injection | Oral tablet |
| Trial Efficacy | 96–100% risk reduction | 69% more effective than oral | Up to 99% when adherent |
| List Price/Year | ~$28,218 | ~$24,000 | $0–$2,000+ (generic) ~$26,000 (Descovy) |
| Free via PAP? | Yes (Gilead MAP) | Yes (ViiV PAP) | Descovy only (Gilead MAP) |
| Provider Visit | 2x/year for injection | 6x/year for injection | 4x/year for labs |
| Self-Administered? | No — healthcare provider | No — healthcare provider | Yes |
| Approved For | All adults at risk | All adults & adolescents at risk | Varies by formulation |
Who Should Consider Injectable PrEP?
Injectable PrEP may be a great fit if you:
- Struggle with daily pills — adherence is the biggest factor in oral PrEP effectiveness. An injection removes the daily commitment entirely.
- Want maximum privacy — no pill bottles, no pharmacy visits, no daily routine that could raise questions.
- Travel frequently — two clinic visits per year (Yeztugo) vs. carrying and remembering pills daily.
- Have had difficulty with oral PrEP side effects — injectable PrEP has a different side effect profile (injection site reactions are common but mild).
- Want the highest possible efficacy — Yeztugo's PURPOSE trial results are the strongest ever recorded for PrEP.
Injectable PrEP may be less ideal if you have needle anxiety, live far from an injection provider, or prefer the flexibility of stopping and starting that oral PrEP offers more easily.
Important note for trans women and people assigned female at birth: Descovy (oral) is not approved for people at risk through vaginal sex who were assigned female at birth. However, Yeztugo and Apretude (injectable) are approved for all adults at risk regardless of sex assigned at birth. This makes injectable PrEP particularly valuable for these populations.
How to Get Your First Injection
Step 1: Talk to a provider
You can discuss injectable PrEP with your regular doctor, an HIV specialist, or through a telehealth platform. MISTR is currently enrolling patients for Yeztugo. Your provider will assess your risk factors, run baseline labs (HIV test, kidney function, hepatitis B), and discuss which option is right for you.
Step 2: Apply for cost assistance
Before your first injection, get your cost coverage sorted. If you have private insurance, confirm with your plan that injectable PrEP is covered. Apply for the Gilead copay card (Yeztugo) or ViiV copay card (Apretude) to cover any out-of-pocket costs. If you're uninsured, apply for the manufacturer PAP.
Step 3: Get your loading doses
Both medications start with a loading phase. Yeztugo begins with oral loading doses before the first injection. Apretude starts with two injections one month apart, then switches to every 2 months.
Step 4: Maintain your schedule
Yeztugo: return for injection every 6 months. Apretude: every 2 months. Your provider will schedule these visits and continue monitoring labs. Missing or delaying injections can reduce protection — set reminders and keep your appointments.
Ready to explore injectable PrEP?
Our eligibility tool includes injectable options and shows which cost assistance programs you qualify for.
Find My Free PrEP PathInjectable PrEP FAQ
Does the injection hurt?
Most people report mild discomfort. Apretude (intramuscular, into the gluteal muscle) tends to cause more injection site reactions — pain, swelling, or hardness at the injection site. These are common but temporary, usually resolving within a week. Yeztugo (subcutaneous, under the skin) is generally reported as less painful.
Can I switch from oral PrEP to injectable?
Yes. Discuss the transition with your provider. They'll typically run updated labs and start you on the injectable loading schedule. There should be no gap in protection if the transition is managed properly.
What if I miss an injection appointment?
Contact your provider as soon as possible to reschedule. Delaying injections can reduce protection. Your provider may recommend bridging with oral PrEP if there's a significant delay. This is more of a concern with Apretude (every 2 months) than Yeztugo (every 6 months).
Is injectable PrEP covered by insurance?
Under the ACA preventive services mandate, most private insurance plans must cover all FDA-approved PrEP at $0 cost-sharing, including injectables. However, some insurers may require prior authorization or step therapy (trying oral PrEP first). Medicaid and Medicare also generally cover it, though details vary by state and plan.
Can injectable PrEP be manufactured cheaply?
Yes. Yeztugo (lenacapavir) can be manufactured for as little as $26–$40 per year. The Gates Foundation and Unitaid have arranged generic production at $40/year for 120 low- and middle-income countries starting in 2027. The US list price of ~$28,218/year reflects the current pharmaceutical pricing structure, not manufacturing costs.