Nearly 6 million Americans took Paxlovid for free thanks to the federal government. A Pfizer pill has helped prevent many people infected with covid-19 from hospitalized or die, and it may even reduce the risk development of prolonged covid. But the government plans to stop paying the bills within months, and the millions of people who are most at risk of severe illness and least able to afford the drug—the uninsured and the elderly—may have to pay the full price.
This means fewer people will receive potentially life-saving treatments, experts say.
“I think the numbers will be much smaller,” said Jill Rosenthal, director of public health policy for the Center for American Progress, a left-wing think tank. A bill of a few hundred dollars or more will make many people decide the drug isn’t worth the price, she said.
In response to the unprecedented public health crisis caused by covid, the federal government has spent billions of dollars developing new vaccines and treatments, with rapid success: Less than a year after the pandemic was declared, healthcare workers received their first vaccines. But since many people have given up vaccinations and stopped wearing masks, the virus is still raging and mutating. In 2022 alone, 250,000 Americans died from covid, more than from stroke or diabetes.
But soon the Department of Health and Human Services will stop supplying drugs to treat COVID-19, and pharmacies will buy and bill them in the same way they would for antibiotic pills or asthma inhalers. Paxlovid is expected to hit the private market in mid-2023, according to HHS plans presented at an October meeting with state officials and doctors. Merck’s Lagevrio, a less effective pill for treating COVID-19, and AstraZeneca’s Evusheld, a preventive therapy for people with weakened immune systems, should hit the market earlier, sometime in the winter.
So far, the US government has 20 million courses Paxlovid is priced at about $530 apiece, a bulk purchase discount that Pfizer CEO Albert Burla called “really very attractive” to the federal government in its July earnings report. In the private market, the drug will cost much more, although Pfizer declined to name the planned price in a statement to KHN. Next year, the government will also stop paying for the company’s coronavirus vaccine — the price of those vaccines will quadruple from a discount rate the government pays of $30 to about $120.
Burla told investors in November that he believes the move would make Paxlovid and its coronavirus vaccine a “multi-billion dollar franchise.”
Near 9 out of 10 people are now dying of the virus at age 65 or older. However, federal law restricts Medicare Part D, a prescription drug program that covers nearly 50 million older people — from coating pills to treat covid. Medicines are for those who are most at risk for serious illness, including the elderly.
Paxlovid and other drugs are currently available under an FDA emergency use authorization, an expedited review used in emergencies. Although Pfizer applied for full approval in June, the process can take from several months to several years. And Medicare Part D cannot cover any drug without full approval.
Paying out-of-pocket will be a “significant barrier” to older people on Medicare, the very people who would benefit the most from the drug. federal health experts.
“From a public health standpoint, and even from a health care opportunity and cost standpoint, it would simply be unwise not to continue to make these drugs readily available,” said Dr. Larry Madoff, Medical Director of the Massachusetts Bureau of Infectious Diseases and Diseases. Laboratory sciences. He hopes the federal health agency will find a way to set aside unused doses for the elderly and uninsured.
In mid-November, the White House asked Congress to approve an additional $2.5 billion in COVID-19 drugs and vaccines so people can afford drugs when they are no longer free. But there is little hope that it will be approved – Senate on the same day voted for the end public health emergency and turned down similar requests in recent months.
Many Americans have already run into roadblocks simply by getting a prescription for COVID-19 treatment. While the federal government doesn’t keep track of who got the drug, Centers for Disease Control and Prevention study using data from 30 medical centers, it was found that black and Hispanic patients with covid were much less likely to receive Paxlovid than white patients. (Hispanics can be of any race or combination of races.) And when the government stops paying the bills, experts predict that these race, income, and geographic gaps will widen.
According to an analysis of Paxlovid use conducted by KHN in September and October, people in the northeastern states used the drug much more frequently than in the rest of the country. But it wasn’t because people in the region got covid much more often — instead, many of those states offered better conditions. access to health care to start and created special programs to bring Paxlovid to their residents.
About 10 mostly Democratic states and several large counties in the Northeast and elsewhere have created free “test cure” programs that allow their residents to get immediate medical visits and treatment appointments after they test positive for covid. In Massachusetts, more than 20,000 residents have taken advantage of public video and telephone hotline, which is available seven days a week in 13 languages. Massachusetts, which has the highest insurance rate in the country and relatively short travel times to pharmacies, had the second highest level of Paxlovid usage among states this fall.
States with higher COVID-19 death rates, such as Florida and Kentucky, whose residents must travel farther to get medical care and are more likely to be uninsured, used the drug less frequently. With no free treatment options from the test, residents have struggled to get prescriptions, even though the drug itself is still free.
“If you look at access to medicines for uninsured people, I think there is no doubt that this inequality will increase,” Rosenthal said.
People who get insurance at work can also face high registry co-payments, as they do for insulin and other expensive or well-known drugs.
According to Sabrina Corlett, research professor at Georgetown University’s Center for Health Insurance Reform, most private insurance companies will eventually cover COVID-19 therapy. After all, the pills are cheaper than a hospital stay. But for most people who get insurance through their jobs, “there aren’t really any rules,” she said. Some insurers may take months to add drugs to their plans or decide not to pay for them.
And the added expense means many people will go without medication. “We know from a lot of research that when people are faced with the challenge of sharing the cost of medications they need to take, they often forgo or cut back on them,” Corlett said.
One group doesn’t need to worry about sticker shock. Medicaid, the government’s insurance program for low-income adults and children, will provide full coverage until at least early 2024.
HHS officials may defer any remaining taxpayer-funded drugs for people who cannot afford to pay the full cost, but they have not shared any specific plans for this. The government purchased 20 million Paxlovid courses and 3 million Lagevrio. Less than a third have been used, according to KHN’s analysis of HHS data, and usage has dropped in recent months.
Sixty percent of the government’s supply of Evusheld is also still available, although COVID-19 prevention therapy has yet to be completed. less efficient against new strains of the virus. Department of health in one state, New Mexicorecommended not to use it.
HHS did not provide officials for interviews and did not respond to written questions about commercialization plans.
The government created a potential workaround when they brought bebtelovimab, another COVID-19 drug, to the private market this summer. It is now selling for $2,100 per patient. The agency has set aside the remaining 60,000 government-purchased doses that hospitals could use to treat uninsured patients in a confusing environment. dose replacement process. But it’s hard to tell how well such a scheme would work for Paxlovid: bebtelovimab was already much less popular, and the FDA stopped using it November 30 because it is less effective against current strains of the virus.
Federal officials and insurance companies would have good reason to make sure that patients can continue to buy coronavirus drugs: they are much cheaper than if patients ended up in the emergency room.
“The drugs are badly needed,” said Madoff, a Massachusetts public health official. “They’re not expensive in the overall health care spending scheme.”
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