A twice-yearly injection that dramatically cuts the risk of getting HIV is one of the most promising advances in prevention — but England’s cost watchdog has declined to fund it on the NHS, at least for now.
NICE (the National Institute for Health and Care Excellence) recommended against NHS funding of Gilead’s lenacapavir for pre-exposure prophylaxis (PrEP), saying it is “not value for money in this population.” Lenacapavir (approved by the UK’s MHRA in December 2025, and by the FDA in June 2025) is a long-acting drug that blocks HIV from multiplying and is given as an injection just twice a year.
Why NICE said no
The sticking point is price. NICE acknowledged lenacapavir reduces HIV risk more than daily oral PrEP — a big deal, because adherence to daily pills is a real-world weakness — but it pointed to an existing injectable option (GSK’s cabotegravir) and cited uncertainties in the evidence and economic modeling, concluding the cost was too high for the NHS.
Why it matters
Advocates argue a twice-yearly shot could reach people who struggle with daily pills and help end new transmissions. Richard Angell of the Terrence Higgins Trust called it “the most exciting innovation in HIV prevention for years”; the National AIDS Trust called the decision “a real missed opportunity.” It’s not necessarily final — a second appraisal committee meeting is set for November 3, 2026, where price negotiations could shift the outcome.