Nearly 6 million Americans have taken Paxlovid for free, thanks to the federal government. The Pfizer pill has helped prevent many people infected with COVID-19 from to be hospitalized or die, and he may even reduce the risk to develop a long COVID. But the government plans to stop footing the bill within months, and millions of people who are at greatest risk of serious illness and least able to afford the drug – the uninsured and the elderly – may have to pay a high price.
And that means fewer people will receive potentially life-saving treatments, experts said.
“I think the numbers will go down,” said Jill Rosenthal, director of public health policy at the Center for American Progress, a left-leaning think tank. A bill of several hundred dollars or more would cause many people to decide the drug isn’t worth its price, she said.
In response to the unprecedented public health crisis caused by COVID, the federal government has spent billions of dollars to develop new vaccines and treatments, with rapid success: less than a year after the pandemic was declared, medical workers received their first vaccines. But as many people have refused injections and stopped wearing masks, the virus is still raging and mutating. In 2022 alone, 250,000 Americans died from COVID-19, more than from strokes or diabetes.
But soon, the Department of Health and Human Services will stop providing COVID-19 treatments, and pharmacies will purchase and charge for them the same way they do antibiotic pills or asthma inhalers. Paxlovid is expected to hit the private market in mid-2023, according to HHS plans shared at an October meeting with state health officials and clinicians. Merck’s Lagevrio, a less effective COVID-19 treatment pill, and AstraZeneca’s Evusheld, a preventative therapy for the immunocompromised, are set to go to market earlier this winter.
The U.S. government has so far purchased 20 million classes of Paxlovid, priced at around $530 each, a bulk purchase discount that Pfizer CEO Albert Bourla called “really very attractive” to the federal government during an earnings call in July . The drug will cost significantly more on the private market, although in a statement to KHN, Pfizer declined to share the expected price. The government will also stop paying for the company’s COVID-19 vaccine next year – these vaccines quadruple the pricefrom the discount rate the government pays from $30 to about $120.
Bourla told investors in November that he expects the move to make Paxlovid and its COVID-19 vaccine “a multi-billion dollar franchise.”
Almost 9 in 10 people who die from the virus are now 65 or older. Yet federal law prevents Medicare Part D — the prescription drug program that covers nearly 50 million seniors — from covering COVID-19 treatment pills. The drugs are intended for people most at risk of serious illness, including the elderly.
Paxlovid and the other treatments are currently available under FDA emergency use authorization, an expedited review used in extraordinary situations. Although Pfizer applied for full approval in June, the process can take months to years. And Medicare Part D cannot cover any drug without this full stamp of approval.
Paying out of pocket would be “a significant hurdle” for older people on Medicare — the very people who would benefit the most from the drug, federal health experts have written.
“From a public health perspective, and even from a health care capacity and cost perspective, it would defy reason not to continue to make these drugs readily available,” said Dr Larry Madoff, medical director of the Massachusetts Bureau of Infectious Diseases and Infectious Diseases. Laboratory science. He hopes the federal health agency will find a way to set aside unused doses for the elderly and those without insurance.
In mid-November, the White House asked Congress to approve an additional $2.5 billion for COVID-19 therapies and vaccines to ensure people can afford the drugs when not in need. more free. But there is little hope of it being approved – the Senate voted the same day to end the public health emergency and has rejected similar demands in recent months.
Many Americans have already encountered obstacles getting a prescription for COVID-19 treatment. Although the federal government does not track who got the drug, a Centers for Disease Control and Prevention study using data from 30 medical centers found that black and Hispanic patients with COVID-19 were significantly less likely to receive Paxlovid than white patients. (Hispanics can be any race or combination of races.) And when the government stops footing the bill, experts predict these gaps by race, income and geography will widen.
People in the northeastern states used the drug significantly more often than those in the rest of the country, according to a KHN analysis of Paxlovid use in September and October. But it wasn’t because people in the region were falling ill with COVID-19 at much higher rates — instead, many of these states were providing better access to health care to begin with and creating special programs to provide Paxlovid to their residents.
A dozen mostly Democratic states and several large counties in the Northeast and elsewhere have created free “test-and-treat” programs that allow their residents to get an immediate medical visit and a prescription for treatment after testing positive for COVID-19. In Massachusetts, more than 20,000 residents used the state’s video and phone hotline, available seven days a week in 13 languages. Massachusetts, which has the highest insurance rate in the nation and relatively low commute times to pharmacies, had the second-highest Paxlovid usage rate among states this fall.
States with higher COVID-19 death rates, such as Florida and Kentucky, where residents must travel farther for health care and are more likely to be uninsured, used the drug less often. Without testing options to treat at no cost, residents struggle to get prescriptions even though the drug itself is still free.
“If you look at access to medications for the uninsured, I think there’s no doubt that those disparities will widen,” Rosenthal said.
People who get insurance through work could also face high copays at the registry, just as they do for insulin and other expensive or brand name drugs.
Most private insurance companies will eventually cover COVID-19 therapies to some extent, said Sabrina Corlette, a research professor at Georgetown University’s Center for Health Insurance Reforms. After all, the pills are cheaper than a hospital stay. But for most people who get insurance through work, there are “really no rules,” she said. Some insurers could take months to add the drugs to their plans or decide not to pay for them.
And the added cost means many people will go without medication. “We know from a lot of research that when people are faced with cost sharing for these drugs that they need to take, they often waive or cut back,” Corlette said.
A group don’t have to worry about sticker shock. Medicaid, the public insurance program for low-income adults and children, will cover full treatment through at least early 2024.
HHS officials could set aside any remaining taxpayer-funded drug for people who can’t afford the full cost, but they haven’t shared any concrete plans for doing so. The government bought 20 million courses from Paxlovid and 3 million from Lagevrio. Less than a third have been used, and use has dropped in recent months, according to KHN’s analysis of HHS data.
Sixty percent of the government’s supply of Evusheld is also still available, although COVID-19 prevention therapy is less effective against new strains of the virus. One state health department, New Mexico, has recommended against its use.
HHS did not make officials available for interview or respond to written questions about the marketing plans.
The government created a potential workaround by moving bebtelovimab, another COVID-19 treatment, to the private market this summer. It now sells for $2,100 per patient. The agency set aside the remaining 60,000 doses purchased by the government that hospitals could use to treat uninsured patients under a convoluted dose replacement process. But it’s hard to say how well that setup would work for Paxlovid: Bebtelovimab was already much less popular, and the FDA discontinued its use on Nov. 30 because it’s less effective against current strains of the virus.
Federal authorities and insurance companies would have good reason to make sure that patients can continue to afford drugs for COVID-19: they are much cheaper than if patients land in the emergency room.
“The drugs are so worth it,” said Madoff, the Massachusetts health official. “They’re not expensive in the grand scheme of health care costs.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
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