CVS Health Excludes Gilead's Yeztugo from Coverage, Analysts Predict 12.80% Upside

CVS Health has opted out of covering Gilead's new HIV drug Yeztugo, citing clinical, financial, and regulatory factors. Analysts predict a 12.80% upside for CVS Health, with a target price of $79.88. The company is rated as "Outperform" and has an estimated GF Value suggesting notable future growth.

CVS Health has opted out of covering Gilead Sciences' new HIV drug Yeztugo, citing clinical, financial, and regulatory factors. The decision was confirmed by a CVS Health spokesperson to Fierce Pharma [1].

Yeztugo, which leverages Gilead’s proven HIV-1 capsid inhibitor lenacapavir, was approved by the FDA in June and is designed to be a breakthrough in HIV prevention by significantly improving convenience and adherence rates compared to daily pills. The drug is dosed just once every six months and has been shown to be around 99% effective at preventing HIV [1].

However, CVS Health has not added Yeztugo to its commercial plans or Affordable Care Act (ACA) formularies. The company's decision is based on a careful review of clinical, financial, and regulatory considerations under the guidance of its external Pharmacy and Therapeutics (P&T) Committee [1]. The USPSTF, which provides recommendations for preventive services, currently includes only three older drugs in its PrEP guidelines [1].

The cost of Yeztugo before discounts and rebates is roughly $28,000 for one year, which CVS Health spokesperson cited as a significant factor in its decision. The company supports the USPSTF guidelines and believes in providing easy access to PrEP medications for people living in the U.S. However, it believes that branded pharmaceutical manufacturers should not manipulate pre-existing guidelines with clinically similar products that are priced far higher than what is already on the market [1].

Despite the coverage rebuff, Gilead may still be negotiating with CVS on Yeztugo. Analysts and doctors alike have predicted that uptake of Yeztugo will be sweeping and swift in the U.S., with a majority of PrEP users expected to switch to the new drug within the next year [1].

Gilead is pleased with the payer talks for Yeztugo and is on track to achieve 75% access for the drug within six months of launch and 90% within 12 months. The company believes that the lifetime cost of treating an HIV patient can exceed $1 million, making preventive treatment cost-effective [1].

The decision by CVS is a significant development in the HIV prevention landscape. While some AIDS activists have expressed disappointment, others recognize the need for a sustainable pricing structure for PrEP medications. The impact of this decision on CVS Health's stock performance remains to be seen, but analysts predict a 12.80% upside for the company, with a target price of $79.88. CVS Health is currently rated as "Outperform" and has an estimated GF Value suggesting notable future growth [2].

References:
[1] https://www.fiercepharma.com/pharma/now-cvs-declines-cover-gileads-twice-yearly-hiv-prep-treatment-yeztugo
[2] https://www.reuters.com/business/healthcare-pharmaceuticals/cvs-holds-off-adding-gileads-new-hiv-prevention-shot-drug-coverage-lists-2025-08-20/