Oct 30, 2023 - Health

Federal coverage of COVID drugs is ending

Photo: Joe Raedle/Getty Images

COVID-19 treatments, including Pfizer's Paxlovid, will begin transitioning to the commercial market this week, with costs of the drugs set to increase.

Why it matters: The oral antivirals reduce the risk of hospitalization or death from COVID-19 and until now have been free for patients through the federal government. The Biden administration and drugmakers have taken steps to ensure access to the treatments after they move to the commercial market.

Details: The shift begins Nov. 1., when Pfizer and Merck, which makes the lesser-used treatment Lagevrio, begin to distribute their antivirals through traditional channels.

  • Millions of free doses procured by the federal government will likely be available across the country in hospitals, doctor's offices and pharmacies for a short time until those treatments run out, federal officials say.

Between the lines: It's still unclear how much commercially insured patients will pay for the drugs through co-pays.

  • Pfizer has said it will price Paxlovid at $1,390 per five-day course, more than double what the federal government paid. That price does not reflect any rebates or negotiated discounts.
  • Merck has not yet confirmed the list price for Lagevrio, per the Associated Press.

Zoom in: The uninsured, and those with Medicare or Medicaid coverage, will be able to get Paxlovid at no cost until the end of 2024.

  • Pfizer is also setting up a patient-assistance program for uninsured and underinsured people, and it will run a co-pay savings program for those with private insurance.
  • Officials say they also expect Merck's patient assistance program will help certain patients.
  • Federal entities including the Indian Health Service, the Department of Veterans Affairs and the Department of Defense will retain access to federally acquired Paxlovid.

What's next: Following a bumpy transition of COVID vaccines to the commercial market, the transition of COVID drugs will be closely watched.

  • "It is of paramount importance that these medications remain widely accessible to high-risk patients after commercial distribution begins in order to minimize hospitalizations and deaths from COVID-19," Health and Human Services Secretary Xavier Becerra said in a letter to manufacturers and distributors on Friday.
Go deeper