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⚠ The ACA Subsidies ExpiredLow threat

Gilead Sciences (GILD) — threat to the moat

The enhanced ACA premium subsidies expired at the end of 2025, a risk to the insured patients Gilead's US HIV business depends on.

Gilead's US business depends on patients having insurance, and one source of coverage weakened at the start of 2026. Its 10-K notes that the enhanced premium subsidies for Affordable Care Act exchange plans "expired at the end of 2025", and that if they are not reinstated, "it is possible that patient enrollment in ACA exchange plans could substantially decrease"1.

Biktarvy US sales ($M)9,692202310,855202411,4672025Gilead Form 10-K FY2025, revenue by product and geography
US sales still growing; the subsidies ended in 2025.

Prevention in particular depends on healthy people choosing to keep paying for insurance, and a drop in exchange enrolment would reach them first.

So far the numbers do not show it: HIV sales grew 12% in the second quarter of 20262. Inventory and price helped that quarter, as the HIV pages explain.

The 10-K places the risk inside a broader warning about US health policy, alongside the IRA and MFN pricing3. For Gilead the exchange plans matter mainly in prevention, where Descovy grew 48% and Yeztugo reached $232 million in the second quarter4. Those are the lines most exposed if healthy, younger people drop their insurance.

The signal to watch is US HIV volume, not revenue. If Gilead reports lower US HIV demand in any 2026 or 2027 quarter, the subsidy expiry will have started to cost patients.

References
  1. ReportedIts 10-K notes that the enhanced premium subsidies for Affordable Care Act exchange plans "expired at the end of 2025", and that if they are not reinstated, "it is possible that patient enrollment in ACA exchange plans could substantially decrease".
    Gilead Sciences Form 10-K for 2025 - Item 1A risk factors and pricing regulation: the IRA, Medicare negotiation, Medicaid, the ACA and tariffs. — FY2025 · publ. 24 February 2026 · source ↗
  2. ReportedSo far the numbers do not show it: HIV sales grew 12% in the second quarter of 2026.
    Gilead Sciences second-quarter 2026 results release, Form 8-K exhibit 99.1 - revenue by product, income statement, cash flow, balance sheet, pipeline updates and 2026 guidance - revenue by product and product group and the drivers of each. — Q2 2026 · publ. 4 August 2026 · source ↗
  3. ReportedThe 10-K places the risk inside a broader warning about US health policy, alongside the IRA and MFN pricing.
    Gilead Sciences Form 10-K for 2025 - Item 1A risk factors and pricing regulation: the IRA, Medicare negotiation, Medicaid, the ACA and tariffs. — FY2025 · publ. 24 February 2026 · source ↗
  4. ReportedFor Gilead the exchange plans matter mainly in prevention, where Descovy grew 48% and Yeztugo reached $232 million in the second quarter.
    Gilead Sciences second-quarter 2026 results release, Form 8-K exhibit 99.1 - revenue by product, income statement, cash flow, balance sheet, pipeline updates and 2026 guidance - revenue by product and product group and the drivers of each. — Q2 2026 · publ. 4 August 2026 · source ↗
Sources
Generated October 4, 2026