Cabotegravir is a highly effective antiretroviral medication used for both the prevention and treatment of HIV-1. It belongs to a class of drugs known as integrase strand transfer inhibitors (INSTIs), which work by blocking the HIV virus from inserting its genetic material into human cells, thus preventing its replication [1.5.1, 1.5.3]. The cost of cabotegravir depends heavily on its brand name, intended use, and a patient's insurance coverage.
Understanding Cabotegravir's Formulations and Brands
Cabotegravir is available in two primary forms, marketed under different brand names for distinct purposes:
- Apretude (injectable cabotegravir): This is a long-acting injectable suspension used for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV [1.6.2, 1.7.3]. After two initial monthly injections, it is administered once every two months by a healthcare provider [1.6.4, 1.6.5].
- Vocabria (oral cabotegravir): These are daily tablets. They are primarily used as a short-term oral lead-in to assess tolerance before starting Apretude injections for PrEP or before starting Cabenuva for HIV treatment [1.6.1, 1.6.3].
- Cabenuva (injectable cabotegravir and rilpivirine): This is a complete HIV treatment regimen that combines cabotegravir with another antiretroviral, rilpivirine [1.6.2]. It is administered monthly or every two months as a treatment for people who are already living with HIV [1.3.1].
The List Price of Cabotegravir
The list price is the price set by the manufacturer before any discounts, insurance, or assistance programs are applied. These prices can be substantial:
- Apretude: The list price for a single 600 mg/3 mL injection of Apretude is approximately $4,125.85 [1.2.3]. Since this is administered every two months, the annual list price is over $24,000.
- Vocabria: The oral lead-in tablets (a 28 or 30-day supply) are often provided at no charge to patients who are prescribed Apretude or Cabenuva [1.2.3, 1.3.1]. When purchased separately, the daily cost can be around $26.52 [1.3.2].
- Cabenuva: The cost varies by dosage. The 400-mg/600-mg kit has a list price of $4,639.33, and the 600-mg/900-mg kit has a list price of $6,958.99 [1.3.1].
It is crucial to note that the retail price a person pays is often significantly different from the list price due to several factors [1.2.6].
Factors Influencing Your Out-of-Pocket Cost
The final amount a patient pays for cabotegravir is influenced by:
- Insurance Coverage: Whether you have commercial insurance, Medicare, or Medicaid significantly impacts your cost. Many insurance plans cover Apretude and Cabenuva, but they may be processed through either pharmacy benefits or medical benefits, requiring a prior authorization [1.4.1, 1.9.3].
- Patient Assistance Programs (PAPs): The manufacturer, ViiV Healthcare, offers extensive support through its ViiVConnect program. These programs can drastically reduce or even eliminate out-of-pocket costs for eligible individuals [1.4.1, 1.4.6].
- Copay Savings Cards: For those with commercial insurance, ViiV offers savings cards that can bring the copay down to as little as $0 [1.4.3, 1.4.6].
- Administration Fees: Since Apretude and Cabenuva are injections administered by a healthcare professional, there may be additional costs for the office visit and the administration of the shot itself [1.2.6].
How to Access Financial Assistance
ViiV Healthcare provides robust financial support for its cabotegravir products. The ViiVConnect program is the central hub for assistance [1.4.5].
- For the Commercially Insured: Patients can enroll in the Patient Savings Program, which can cover most or all of their copay costs [1.4.1].
- For the Uninsured or Underinsured: The ViiV Healthcare Patient Assistance Program may provide the medication at no cost to individuals who meet certain income and residency eligibility requirements [1.4.2, 1.4.4].
- For Medicare/Medicaid Patients: While these patients aren't eligible for the copay card, ViiVConnect can help them find other potential sources of funding and support [1.4.1].
To get help, you can call ViiVConnect at 1-844-588-3288 or visit their website [1.4.4, 1.4.5]. Data shows that after assistance options, most people pay $0 per dose [1.4.1].
Cabotegravir vs. Other HIV Medications
When considering cost and convenience, it's helpful to compare Apretude to daily oral PrEP options like Truvada and Descovy. While Apretude has been shown to be more effective than Truvada at preventing HIV, it comes with a higher list price [1.7.1, 1.7.4].
| Feature | Apretude (Cabotegravir) | Truvada (Emtricitabine/TDF) | Descovy (Emtricitabine/TAF) |
|---|---|---|---|
| Administration | Bimonthly Injection | Once-Daily Oral Pill | Once-Daily Oral Pill |
| Annual List Price | ~$28,000 [1.2.2] | ~$24,000 (Brand) | >$24,000 (Brand) |
| Generic Available? | No [1.9.1, 1.9.4] | Yes (~$30/month) [1.2.1] | No |
| Efficacy | Superior to Truvada in studies [1.7.1] | Highly Effective | Highly Effective |
| Common Side Effects | Injection site reactions, headache, fever [1.8.5] | Nausea, headache [1.7.5] | Diarrhea, nausea [1.7.3] |
Conclusion
While the list price for cabotegravir, particularly the injectable Apretude, is high, it does not reflect what most patients will actually pay. Due to comprehensive insurance coverage and robust manufacturer assistance programs like ViiVConnect, many eligible individuals can access this long-acting PrEP and treatment option with little to no out-of-pocket cost [1.4.1]. The convenience of a bimonthly injection over a daily pill is a significant advantage for adherence, and clinical trials have proven its superior efficacy for HIV prevention compared to older oral options [1.7.1, 1.7.5]. Patients interested in cabotegravir should speak with their healthcare provider and contact ViiVConnect to get a clear picture of their potential costs. Currently, there are no generic versions of Apretude or Cabenuva available [1.9.1, 1.9.2].
Disclaimer: This article provides information about medication costs and assistance programs. It is not medical advice. Consult with a healthcare professional and your insurance provider for personalized information.
