IAS President Calls for Price Transparency in Gilead-Global Fund Lenacapavir Agreement | IAS 2025

Beatriz Grinsztejn, M.D., Ph.D.

The president of the International AIDS Society (IAS) is calling for more transparency about the pricing of lenacapavir in the access agreement that Gilead Sciences has signed with The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) to supply 2 million doses of the groundbreaking preexposure prophylaxis (PrEP) medication.

In her remarks at the opening ceremony of the IAS meeting in Kigali, Rwanda, on Monday and at a press conference on Tuesday, the IAS president, Beatriz Grinsztejn, M.D., Ph.D., referenced the lack of transparency in the agreement between Gilead and the Global Fund that was announced last week.

At the press conference, Grinsztejn said that disclosure of the price is important to middle-income countries such as Brazil that are negotiating price and access to lenacapavir separately because they aren’t among the countries that will be supplied the PrEP drug through the Global Fund agreement.

“The actual price of this agreement between the Global Fund and Gilead is not transparent,” she said at the press conference. “So for countries that are not included in this group of countries that will be benefited by this agreement, we have no basis to start the conversation.”

Grinsztejn is a leading HIV researcher in Brazil and director of the HIV/AIDS clinical research unit at the Evandro Chagas National Institute of Infectious Diseases—FIOCRUZ in Rio de Janeiro.

A Gilead spokesperson said in a prepared statement yesterday that the price under the Gilead-Global Fund is confidential but that it reflects the cost of producing and delivering lenacapavir at no profit to Gilead. The statement says that for middle-income countries not covered by the agreement, the company Gilead is prioritizing timely registration, ramping up manufacturing to meet demand, and exploring tiered pricing.

The FDA approved lenacapavir for PrEP on June 18, 2025. Because it is nearly 100% efficacious at preventing HIV and has a twice-a-year dosing schedule, lenacapavir is being heralded as a possible breakthrough in HIV prevention and goals to end HIV as a worldwide public health threat. But questions about whether lenacapavir, which Gilead is marketing under the brand name Yeztugo, will be used hover over its potential, and the uptake hinges on many issues, including the price. For the U.S., Gilead has set a list price of $28,218, although, as is typical with drug prices in the U.S., payers such as Medicaid plans and employer-based health plans are expected to negotiate markdowns from that list price.

To address price and access elsewhere in the world, Gilead has said it has signed royalty-free licensing agreements with generic manufacturers to supply lenacapavir to 120 low- and middle-income countries with a high incidence of HIV. During the period before those generic versions are available, the company has said it was committed to making lenacapavir available at a price that didn’t yield any profit for the company in those 120 countries.

In its news release last week about the deal with Gilead, the Global Fund trumpeted the agreement as a “significant milestone for global health equity” because, the release said, it will be the first time that an HIV prevention product will be introduced in low- and middle-income countries at the same time as in high-income countries.

PrEP has been the central topic of this year’s IAS meeting, and positive clinical trial results for lenacapavir were the major story that emerged from last year’s meeting in Munich. According to the U.S. State Department, the U.S. President's Emergency Plan for AIDS Relief, better known as PEPFAR, has funded more than 90% of PrEP initiations for HIV prevention globally. As a result, the Trump administration’s pullback of PEPFAR funding has become a major factor in PrEP use and planning. The rescission spending bill that includes major cuts to foreign aid and public media that the Senate narrowly passed yesterday did not, in the end, include a $400 million cut in PEPFAR funding proposed by the White House.

“News that the U.S. Senate plans to remove PEPFAR from proposed budget cuts is very welcome,” Grinsztejn said in a prepared statement. “The International AIDS Society urges lawmakers to keep supporting this life-saving programme and the global HIV response.”