IDWeek 2025: Reduced pricing for lenacapavir is possible and profitable

The HIV drug lenacapavir (Gilead) could be sold at one-thousandth of its current list price and still make a profit, according to a new study presented at IDWeek 2025, in Atlanta.

Lenacapavir, which can both be used as pre-exposure prophylaxis and in HIV treatment, is currently sold at a list price of more than $28,000 in the United States. The new study (oral abstract 174), led by Joseph Fortunak, PhD, a professor of chemistry and pharmaceutical sciences at Howard University, in Washington, D.C., revealed that the drugmaker could license manufacturers to produce a generic version at $35 to 46 per patient per year for 2 million patients, and if that volume increased to at least 5 million patients, the cost could fall to $25 per patient per year.

At the same time, the researchers propose that high-income countries could shoulder a cost of $2,000 per patient per year, which would help to pay for the drugmaker’s research and development costs, according to presenting author Andrew Hill, PhD, a senior visiting research fellow at Liverpool University, in England.

“We’ve been meeting the main Indian and Chinese suppliers. Our research team has predicted accurately the drugs for other diseases in the past,” Dr. Hill said. In addition, their pricing modeling incorporated a 30% profit margin and a 27% tax rate.

Supply and Demand

The pricing is not completely unprecedented, Dr. Hill explained. “The President’s Emergency Plan for AIDS Relief has agreed to an initial supply of lenacapavir for $64 per person per year to treat approximately a million people per year,” he said. “Now, unfortunately, that level of supply is not large enough to have a significant effect on the HIV epidemic worldwide.” After cuts in HIV funding, HIV incidence is expected to increase from 1.3 million to 2.9 million worldwide, he said.

Lenacapavir for 1 million people would only prevent 50,000 HIV infections worldwide, he noted. But other groups are coming to the table, too. “By next year, the Gates Foundation, Clinton Foundation, and parts of the United Nations have arranged a price of $40,” he said.

These pricing issues are not unique to lenacapavir. Another long-acting injectable, cabotegravir (ViiV Healthcare) has been similar. The current cabotegravir pricing has also kept use low in the United States and Europe, Dr. Hill continued. “It’s simply not being used across Europe. It’s been rejected by the healthcare authorities as not cost-effective and too expensive,” he said. “And even in the United States, the amount of drug that’s been used has only prevented approximately 400 HIV infections in the United States, out of 39,000 new diagnoses last year. It’s 1.1%.”

$25 Versus $2,000

The devised split for $25 for low- and middle-income countries and $2,000 for high-income countries is meant to have wealthier countries shoulder the burden of drug development. It’s reduced from the current pricing, but still much higher per person than that of pricing for the rest of the world. “The high-income countries need to pay for research and development, but we could pay for large numbers of people to be treated at a low price, or smaller numbers at a high price. We need to upscale this, and the company makes money either way,” Dr. Hill told Infectious Disease Special Edition.

And groups will need to come together to help pay to get these drugs to the people who need them, he told IDSE. “We do need an alliance between the main state payors and the drug company. We need to have a volume-based agreement,” he said. “We all want the HIV epidemic to end, but we need the unit price to be a tiny fraction of what it is now to reach the numbers that we need to actually turn the epidemic around.”

By Meaghan Lee Callaghan