Provider Briefing: Biktarvy Availability in 2026

Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) remains the most prescribed antiretroviral regimen in the United States, with an estimated 430,000+ patients currently on treatment. As the cornerstone of many HIV practices, any disruption in availability directly impacts patient outcomes and clinical workflows.

This briefing provides an up-to-date overview of Biktarvy's supply status, prescribing considerations, cost landscape, and practical tools to help your patients maintain uninterrupted therapy.

Current Supply Timeline

As of February 2026, Biktarvy is not listed on the FDA Drug Shortage database. Gilead Sciences reports that manufacturing and distribution are operating at normal capacity.

However, anecdotal reports from patients and clinicians indicate that individual pharmacy stock-outs remain common, particularly at large chain retail pharmacies. These localized availability issues stem from distribution patterns and inventory management decisions rather than a true supply-demand mismatch at the national level.

Key timeline notes:

• FDA approval: February 2018
• Market leadership: #1 prescribed HIV treatment since mid-2018 (per IQVIA data)
• Generic status: No generic available in the U.S. as of 2026
• Pediatric expansion: Approved for patients ≥14 kg with lower-dose tablet (30/120/15 mg)

Prescribing Implications

For clinicians managing HIV patients on Biktarvy, the current landscape presents several considerations:

Treatment Continuity

Uninterrupted antiretroviral therapy is critical for maintaining viral suppression and preventing resistance. Even brief treatment interruptions can lead to viral rebound and, in rare cases, development of resistance mutations — particularly to the NRTI backbone.

Clinical recommendation: Encourage patients to refill 5-7 days early and to use real-time pharmacy stock tools like Medfinder for Providers to identify pharmacies with current availability before sending prescriptions.

Contraindications and Drug Interactions

When patients present with availability concerns, providers may need to consider alternative regimens. Key Biktarvy-specific considerations for the switch discussion:

• Contraindicated co-medications: Dofetilide (arrhythmia risk), rifampin (subtherapeutic bictegravir levels)
• Significant interactions: Carbamazepine, oxcarbazepine, phenobarbital, phenytoin, St. John's wort (all reduce bictegravir levels)
• Separation requirements: Aluminum/magnesium antacids, iron, and calcium supplements (separate by 2+ hours or take Biktarvy with food)
• Hepatitis B: Biktarvy contains emtricitabine and TAF, both active against HBV. Discontinuation in co-infected patients carries a boxed warning for HBV flare.

Special Populations

• Pregnancy: Limited data. DHHS guidelines discuss use in pregnancy — weigh risks and benefits.
• Renal impairment: Not recommended if CrCl <30 mL/min. No dose adjustment for CrCl ≥30.
• Hepatic impairment: Not recommended in severe hepatic impairment (Child-Pugh C).
• Pediatrics: Approved ≥14 kg. Two tablet strengths available: 50/200/25 mg (≥25 kg) and 30/120/15 mg (14 to <25 kg).

Current Availability Picture

The availability challenges with Biktarvy are best characterized as a "last mile" distribution problem rather than a supply shortage:

• Specialty pharmacies: Generally maintain adequate stock due to dedicated HIV medication inventory
• Chain retail pharmacies: Inconsistent stocking — many locations don't carry Biktarvy routinely due to lower per-location HIV patient volume
• Independent pharmacies: Often better positioned to order on demand from wholesalers, with delivery in 24-48 hours
• Mail-order pharmacies: Typically reliable supply with direct-to-patient delivery

Practices that routinely manage HIV patients should consider establishing relationships with pharmacies that reliably stock antiretroviral medications.

Cost and Access Landscape

Cost remains a significant factor in Biktarvy access:

• AWP/Cash price: ~$3,500–$4,000 per 30-day supply
• Commercial insurance: Generally covered; copays vary ($0–$100+/month)
• Gilead copay card: Eligible commercially insured patients may pay $0/month
• Medicare Part D: Covered by most plans; Part D redesign may affect out-of-pocket costs
• Medicaid/ADAP: Covered in most states
• 340B pricing: Available to eligible covered entities

For patients experiencing cost barriers, the following resources may help:

• Gilead Advancing Access: Copay assistance, free drug programs, and insurance navigation (gileadadvancingaccess.com, 1-800-226-2056)
• Patient Advocate Foundation: Copay relief and case management
• PAN Foundation / HealthWell Foundation: HIV copay assistance funds (when open)

Tools and Resources for Providers

Several tools can help streamline the process of getting patients their medication:

• Medfinder for Providers: Real-time pharmacy stock checker — verify availability before prescribing to a specific pharmacy
• Gilead Advancing Access portal: Provider enrollment, prior authorization support, and patient assistance applications
• Specialty pharmacy networks: Consider maintaining a short list of pharmacies that reliably stock Biktarvy for patient referrals

Alternative Regimens When Switching Is Necessary

If a patient cannot access Biktarvy and a switch is clinically warranted, consider these DHHS guideline-recommended alternatives:

• Dovato (dolutegravir/lamivudine): Two-drug INSTI-based regimen. Not suitable for HBV co-infection or patients with prior NRTI resistance.
• Triumeq (dolutegravir/abacavir/lamivudine): Requires HLA-B*5701 negative status. Not suitable for HBV co-infection.
• Symtuza (darunavir/cobicistat/emtricitabine/TAF): PI-based single-tablet regimen. More drug interactions due to cobicistat.
• Cabenuva (cabotegravir/rilpivirine): Long-acting injectable. Requires oral lead-in and virologic suppression. Not pharmacy stock-dependent in the same way.

Document resistance testing results and review them before any switch. See our patient-facing alternatives guide for additional context.

Looking Ahead

The HIV treatment pipeline continues to expand with long-acting and novel-mechanism options:

• Lenacapavir (Sunlenca): First-in-class capsid inhibitor, approved for treatment-experienced patients, given subcutaneously every 6 months
• Long-acting cabotegravir combinations: Expanding indications and dosing intervals
• Potential future generics: Patent expirations will eventually open the market, though no specific timeline has been set for Biktarvy generics in the U.S.

Final Thoughts

Biktarvy remains a cornerstone of HIV treatment with no active national shortage. The challenges patients face in filling prescriptions are distribution-related and can be addressed with proactive pharmacy management and real-time stock tools.

As a provider, your role in maintaining treatment continuity is critical. Use Medfinder for Providers to verify stock before sending prescriptions, establish relationships with reliable pharmacy partners, and ensure patients have access to Gilead's support programs.

Related provider resources: How to help your patients find Biktarvy in stock | Provider's guide to saving patients money on Biktarvy