Gilead says Medicare price will cut about $1.5 billion from Biktarvy in 2028

Gilead's biggest medicine now has a date for a lower price. In its third-quarter results the company said the US Medicare programme had finished setting a negotiated price for Biktarvy, its once-daily HIV pill, and that the new price starts to cut Biktarvy revenue on 1 January 2028. On its earnings call management added the detail: $2,600 for a 30-day supply, about 38% below the list price in Medicare, and a preliminary estimate that Biktarvy loses about $1.5 billion of net revenue in that year.

The estimate reaches beyond Medicare. Management said it also covers knock-on effects in Medicaid, the federal discount scheme for safety-net hospitals and other payers, and that it is net of the Medicare drug-benefit redesign cost Biktarvy already carries, which falls away at the same time. For scale, Biktarvy sold $11,193 million in the first nine months of this year; the estimated loss equals 13.4% of that, calculated from the reported figures. Chief executive Daniel O'Day said "the price set by CMS does not reflect the value of Biktarvy".

Management still expects total HIV revenue to grow in the year the new price starts, carried by other products in the range, and expects total product sales and earnings per share to grow as well. It called these statements assumptions that may change, with formal guidance due early in that year. Whether that holds depends on what is driving HIV sales now.

In the September 2026 quarter HIV sales rose $972 million from a year earlier, to $6,249 million. The company put the rise down to higher average realized prices, more demand for HIV prevention and favourable inventory movements. Three drugs did all of the work, and the rest of the HIV range slipped slightly.

Part of that gain came from price and stocking. Descovy, a daily pill that Gilead sells mostly for HIV prevention (about 80% of its sales), grew 49%, and the company credited the rise primarily to higher realized prices and inventory. Management also expects less stocking in the fourth quarter after a large build in the third. The company named higher demand for both Biktarvy and HIV prevention; management said the offset for Biktarvy will come from across its HIV range, treatment and prevention, as well as oncology and inflammation.

Yeztugo, Gilead's newest HIV prevention drug, is guided to sales of about $1 billion for this year and had sold $702 million by the end of September; the estimated Biktarvy loss is larger than that whole year. Johanna Mercier, one of the executives on the call, said the company has about a year to look for ways to offset as much of it as it can, on top of growth from the rest of the portfolio.

The company comes to this with momentum and cash. It raised its full-year forecast for product sales excluding Veklury above the range it gave in August, and generated $5.0 billion of operating cash in the quarter. Management also pointed to policy costs it has already dealt with, including $1.1 billion from the Medicare drug-benefit redesign last year.

What the numbers settle is narrower than the 2028 growth statement. The size of the Biktarvy loss is now estimated, its start date is fixed, and Yeztugo, the newest prevention product, sold less in the first nine months of this year than the estimate. Part of last quarter's HIV rise came from price and stocking. Management said the estimate is "primarily Medicare" but would not split it further, and has not sized any offset; it may update the 2028 view at any time, including with formal guidance in early 2028.