How Much Does Cabenuva Cost With Medicare?
Cabenuva (Cabotegravir/Rilpivirine) costs an average of $6,593 per Medicare Part D claim, with total Medicare spending of $567.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Key Facts: Cabenuva Cost
- Medicare Part D avg
- $6,593/claim
- Likely Part D tier
- Tier 4-5 (specialty)
- Annual cost/patient
- $78,750
- Generic available
- Yes — Cabotegravir/Rilpivirine
- Manufacturer
- ViiV Healthcare
- Treats
- HIV
- YoY price change
- +86.4%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Cabenuva Medicare Coverage & Out-of-Pocket Cost
Cabenuva is covered under Medicare Part D, with the program paying an average of $6,593 per prescription fill. Cabenuva typically falls on Tier 4-5 (specialty) of standard Part D formularies. Specialty drugs use coinsurance (25-33% of plan-negotiated price), not flat copays. The 2025 Part D annual out-of-pocket cap is $2,000.
Your actual out-of-pocket cost depends on three factors: (1) formulary tier — your plan's specific placement; (2) deductible status — most plans require you to meet up to a $590 deductible (2025) before copays kick in; (3) coverage phase — initial coverage, then the donut hole was eliminated in 2025, replaced by a hard $2,000 annual out-of-pocket cap under the Inflation Reduction Act. Once you hit $2,000 in true out-of-pocket spending, the rest of your Part D drugs are free for the year.
Because generic Cabotegravir/Rilpivirine is available, the single biggest savings move is asking your pharmacist about generic substitution. Generics typically sit on Tier 1 with copays under $10, vs Tier 2-3 placement for brand-name Cabenuva. Most states allow automatic substitution unless your prescriber writes "dispense as written."
For cash-pay or commercial insurance scenarios, compare prices using GoodRx, SingleCare, or Cost Plus Drugs before filling — discount-program prices sometimes beat Part D copays for lower-cost generics.
Cabenuva is manufactured by ViiV Healthcare and prescribed primarily for HIV. In the most recent Medicare Part D data, 86,000 claims were filed for 7,200 unique beneficiaries, at an average cost of $6,593 per claim. Average annual cost per beneficiary is $78,750.
Year over year, Medicare spending on Cabenuva has increased by +86.4%. Because a generic version of Cabotegravir/Rilpivirine is available, patients can often substitute to reduce out-of-pocket costs. Its patent expires 2023-01-31.
Cabenuva belongs to the HIV Antiretrovirals class. Modern HIV treatment uses 2-3 drugs combined in one pill. Integrase strand transfer inhibitors (INSTIs like bictegravir in Biktarvy) block HIV from inserting its genetic material into human cells. NRTIs (tenofovir, emtricitabine) block the virus from copying its RNA into DNA. The combination prevents resistance. Once-daily single-tablet regimens achieve >95% viral suppression.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $6,593 |
| Total Medicare Spending | $567.0M |
| Total Claims | 86,000 |
| Beneficiaries | 7,200 |
| Generic Available | Yes |
| Year-Over-Year Change | +86.4% |
Other Drugs for HIV
Frequently Asked Questions
Medicare Part D pays an average of $6,593 per claim for Cabenuva. Cabenuva is typically placed on Tier 4-5 (specialty) of standard Part D formularies. Specialty drugs use coinsurance (25-33% of plan-negotiated price), not flat copays. The 2025 Part D annual out-of-pocket cap is $2,000. As of 2025, total annual out-of-pocket on Part D is capped at $2,000 under the Inflation Reduction Act.
Yes. Cabenuva appears in Medicare Part D claims data, with 7,200 beneficiaries filling 86,000 prescriptions in the latest year. Specific coverage depends on your plan's formulary — call the number on your insurance card or check the plan's Summary of Benefits to confirm prior authorization, step therapy, or quantity limit requirements.
Cabenuva (Cabotegravir/Rilpivirine) costs an average of $6,593 per Medicare Part D claim, with total Medicare spending of $567.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Yes. A generic version of Cabotegravir/Rilpivirine is available, which typically costs 80-95% less than brand-name Cabenuva. Ask your pharmacist about generic substitution — most state laws allow automatic substitution unless your prescriber writes "dispense as written."
Medicare beneficiaries cannot use manufacturer copay cards (anti-kickback statute), but several options exist: (1) Apply to charity copay foundations like the PAN Foundation, NeedyMeds, HealthWell Foundation, or Patient Advocate Foundation — many cover hiv drugs; (2) Ask your prescriber about therapeutic alternatives in the same drug class that may be on a lower tier; (3) For some drugs, paying cash via GoodRx or Cost Plus Drugs can beat your Medicare copay — always compare before filling; (4) If your income is below 150% of the federal poverty level, you may qualify for the Medicare Extra Help (Low-Income Subsidy) program, which reduces Part D costs to near-zero.
Cabenuva is manufactured by ViiV Healthcare. The FDA application number is BLA125057.
Cabenuva (Cabotegravir/Rilpivirine) is primarily prescribed for HIV.
Medicare Part D spending on Cabenuva has increased +86.4% year over year. Total program spending reached $567.0M in the latest reporting year.
Cabenuva (Cabotegravir/Rilpivirine) costs an average of $6,593 per Medicare Part D claim, with total Medicare spending of $567.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
The data source behind this answer is CMS Medicare Part D Drug Spending data. Every figure on the page traces back to that source; the methodology page describes the inputs and the refresh cadence in full detail.
A practical caveat: the headline answer above reflects the most recent CMS Medicare Part D Drug Spending data vintage; underlying data is often revised for months after first publication, and the right reference for any specific decision is whichever vintage is current at the time of the decision. The as-of date is stamped on every page.
Source: CMS Medicare Part D Spending, 2026.