Apretude is long-acting injectable cabotegravir used for PrEP, HIV pre-exposure prophylaxis. It is given as a single gluteal injection by a clinician, and after two initiation doses a month apart it moves to a shot every two months. Six appointments a year replace 365 pills.
That convenience has a price, and the price sits in an unusual regulatory position. PrEP is one of the few expensive drugs in American healthcare that federal rules say most insured people should get for free, along with the lab work around it. This guide covers both the real dollar figure and the rule that is supposed to keep you from seeing it. All figures were verified on September 2, 2026.
What Does Apretude Cost Without Insurance?
Two sources anchor the drug price. ViiV Healthcare publishes its own list price, and CMS publishes the Medicare Part B payment limit, calculated from average sales price rather than list. They land within 1% of each other.
| Component | Low | Typical | High |
|---|---|---|---|
| Apretude 600 mg / 3 mL kit, drug only | $4,334.72 | $4,334.72 | $4,376.40 |
| Injection administration, per visit | $13.42 (Medicare allowed) | $15.36 to $15.44 (2026 Medicare rate) | $55.33 (average charge submitted) |
| Optional oral lead-in (Vocabria, 28 days) | $0 | $0 | $0 |
| Year 1, 7 injections, drug only | $30,343 | $30,343 | $30,635 |
| Maintenance year, 6 injections, drug only | $26,008 | $26,008 | $26,258 |
| Generic oral PrEP, 30 days (acquisition cost) | $13.99 | $15.15 | $15.15 |
| Brand Descovy for PrEP, 30 days (acquisition cost) | $2,248.24 | $2,248.24 | $2,248.24 |
ViiV’s US pricing page, updated July 1, 2026, lists the 600 mg / 3 mL Apretude kit at $4,334.72, sourced to ViiV Healthcare data on file as of July 1, 2026. The same table states that Vocabria, the optional 28-day oral lead-in, is “available at no charge for oral lead-in to patients prescribed APRETUDE.”
CMS’s July 2026 Medicare Part B Drug Payment Limit File lists HCPCS code J0739, “Hiv prep, inj, cabotegravir,” at $7.294 per mg. A 600 mg dose is therefore $4,376.40. Medicare’s limit is 106% of average sales price, so a limit slightly above list price tells you the drug is not moving at a meaningful discount anywhere in the distribution channel.
The first year costs more than every year after it
ViiV’s dosing guidance is that Apretude is given as two initiation injections one month apart and then a single 600 mg gluteal injection every two months. Count the calendar: injections land in months 1, 2, 4, 6, 8, 10 and 12 of the first year, which is seven doses, then six doses annually after that.
At list price that is $30,343.04 in year one and $26,008.32 in a maintenance year, drug only. At Medicare’s payment limit it is $30,634.80 and $26,258.40. Add the injection administration charge at each visit, plus the HIV test that has to happen at every injection visit, plus whatever the clinic bills for the appointment.
The comparison that reframes the number
The same protection, in tablet form, costs about a thousandth as much. CMS NADAC data effective August 19, 2026 puts generic emtricitabine with tenofovir disoproxil fumarate at $0.50510 per tablet, roughly $15.15 for a 30-day supply, and Cost Plus Drugs lists a bottle of the same generic at $13.99, of which $7.82 is manufacturing cost and $1.17 is its standard 15% markup. Brand Truvada is $59.62359 per tablet at acquisition cost and Descovy is $74.94147.
That is not an argument against Apretude, which exists because daily adherence is hard and because some people cannot use the oral options. It is context for what you are actually buying, which is a delivery system rather than a stronger drug.
What Drives the Price
It is a brand-only long-acting formulation. Cabotegravir is a ViiV molecule with no generic, and the extended-release nanosuspension that lets one shot last two months is the expensive part. Oral PrEP genericized years ago and collapsed to about fifty cents a tablet. Apretude will not do that for a long time.
Seven doses in year one, six after. The loading schedule adds one full injection to the first twelve months, about $4,335 at list. If someone quotes you an annual Apretude price, ask which year they are quoting.
The administration fee on top of the drug. Apretude is one intramuscular injection, so a clinic bills one unit of the therapeutic injection administration code, CPT 96372. CMS’s own July 2026 physician fee schedule relative value file gives that code 0.17 work RVUs, 0.28 practice expense RVUs and 0.01 malpractice RVUs, for 0.46 total. Multiplied by the two 2026 conversion factors in the same file, $33.4009 and $33.5675, that is $15.36 to $15.44 nationally before geographic adjustment. What providers actually charge is higher: CMS’s 2024 national utilization data shows an average submitted charge of $55.33 per injection in an office setting, against an average Medicare allowed amount of $13.42. Small money next to a $4,300 drug, but it is a separate line on the bill and it recurs six or seven times a year.
The ancillary services that come with it. PrEP is not a drug you take alone. CDC’s PrEP page, updated April 15, 2026, says you must test negative for HIV before starting and then return routinely for follow-up visits, HIV tests and shots. Federal guidance treats those baseline and monitoring services as part of the covered preventive benefit rather than as separate charges, which matters enormously to whether your bill is $0 or several hundred dollars a visit.
Where the shot is given. A hospital outpatient department can attach a facility fee to the same injection that a Ryan White clinic, a health department or a family practice office bills without one. Our guide to hospital price transparency covers how to look up a site’s posted rate first.
Cash Price vs. Insurance
This is the rare drug where the insurance answer is not “it depends,” and where knowing the rule is worth real money.
On August 22, 2023 the U.S. Preventive Services Task Force issued a grade A recommendation that clinicians prescribe PrEP with effective antiretroviral therapy to people at increased risk of HIV acquisition. The recommendation names three FDA-approved formulations: oral tenofovir disoproxil fumarate with emtricitabine, oral tenofovir alafenamide with emtricitabine, and injectable cabotegravir, which is Apretude.
On October 21, 2024 the Departments of Health and Human Services, Labor and the Treasury issued FAQs About Affordable Care Act Implementation Part 68. That guidance states that plans and issuers “must cover, without cost sharing, specified oral and injectable formulations of PrEP, as well as specified baseline and monitoring services,” for plan years beginning on or after August 31, 2024. It also states that plans “must cover, without cost sharing, the three FDA-approved PrEP formulations (two oral and one injectable) and are not permitted to use medical management techniques to direct individuals prescribed PrEP to utilize one formulation over another.”
That last clause is the one to quote in an appeal. A plan cannot legally require you to fail on generic oral PrEP before it will cover Apretude without cost sharing.
Medicare has its own version. CMS states that as of September 30, 2024, Part B covers FDA-approved PrEP drugs, administration of injectable PrEP, dispensing or supplying the drug, up to eight individual counseling visits every 12 months, up to eight HIV screenings every 12 months and a one-time hepatitis B screening, all without deductibles, copayments or coinsurance. CDC’s own summary is blunter: “Under the Affordable Care Act, PrEP must be free under almost all health insurance plans. That means you can’t be charged for your medication, clinic visits, and lab tests needed to maintain your prescription.”
For a cash payer, all of that describes a benefit you do not have. The zero cost-sharing rule attaches to insurance coverage, not to the drug. What an uninsured person faces instead is a $4,334.72 list price per shot, plus the labs and visits that insured people get folded in for free. That gap is the strongest argument on this page for getting enrolled in something, whether that is Medicaid, a marketplace plan or a manufacturer program.
How to Pay Less
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Apply to the ViiV Healthcare Patient Assistance Program before your first injection. Its posted criteria are that you reside in the 50 states, DC or Puerto Rico, are uninsured, meet financial income criteria, and are not enrolled in ADAP, Medicaid, another state or federal health plan, or an alternate funding program. Apply through gskpaf.org or call 1-844-588-3288. Refills for Apretude run through a dedicated line. Do this before a clinic orders a kit for you.
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Check whether your state runs a PrEP assistance program. CDC notes that some states cover PrEP medication, some cover the clinic visits and lab tests, and some cover both. These are separate from ADAP and separate from manufacturer help, and they are the piece that covers the ancillary services a manufacturer program will not.
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If you have insurance and are being charged, appeal with the guidance in hand. Cite FAQs Part 68 and the USPSTF grade A recommendation, and name the specific rule that plans may not steer you toward a different formulation. Also check whether the claim was processed under your medical benefit or pharmacy benefit, because a preventive service billed with the wrong code is one of the more common reasons a $0 service produces a bill.
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Price the oral options honestly before committing to injections. Generic oral PrEP is about $15 a month at acquisition cost against $4,335 a shot. If cost is the binding constraint and daily dosing is workable for you, that conversation belongs with your prescriber. Our PrEP cost guide prices the oral shelf in detail.
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Get the shot somewhere without a facility fee. A health department, a Ryan White clinic or a federally qualified health center will not add a hospital outpatient charge to a fifteen-minute injection. Our guide to free and sliding-scale clinics explains how to find one and what income documentation to bring.
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Budget for the labs separately, or find them bundled. Every injection visit involves HIV testing, and PrEP also typically involves STI screening and kidney function checks. Our STD testing cost guide and blood work cost guide price those, and our fair price checker will tell you whether a quote you have been given is in range.
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Do not let an injection bill sit. If a clinic has already administered a dose and sent you a four-figure charge, that is a negotiable medical bill like any other. Our guide to negotiating medical bills has the scripts, and hospital charity care applies if the site is hospital-owned.
Bottom Line
Apretude costs $4,334.72 to $4,376.40 per injection in 2026, which is about $30,300 in the first year and $26,000 a year after that, plus roughly $15 to $55 per visit for the shot itself and the recurring HIV testing that goes with it.
If you have insurance, you should be paying none of that, and the October 2024 federal guidance says so explicitly, including for the labs and visits. If you do not have insurance, the manufacturer assistance program and your state’s PrEP program are the routes that produce a workable number, and generic oral PrEP at roughly $15 a month is the fallback that keeps protection continuous while paperwork is pending.
For the treatment side of the same class, see our Cabenuva cost guide, which prices the long-acting injectable HIV treatment regimen, and our Biktarvy cost guide for the daily single-tablet regimen. Our doctor visit cost guide prices the appointments that come with the shots.