Up until now, the federal government has footed the bill for Covid-19 vaccines and treatments, including the antiviral Paxlovid. But that is likely to change over the next few months—which could make it harder for people, especially the uninsured and older Americans, to access treatments, Hannah Recht writes for Kaiser Health News.

Covid-19 treatments will soon be reimbursed through the commercial market

With federal appropriations for Covid-19 vaccines and treatments dwindling, the Biden administration has signaled a transition to a more standard purchasing process in which commercial insurers and pharmacy benefit managers will increasingly pay for treatments.

In August, the Biden administration stopped directly providing monoclonal antibody treatments, and Eli Lilly shifted its Covid-19 monoclonal antibody treatment to commercial sales for states, hospitals, and other health care providers. Other treatments, including Merck's antiviral pill Lagevrio and AstraZeneca's preventive therapy Evusheld, will likely be commercialized this winter.

Pfizer's Covid-19 antiviral drug Paxlovid is expected to follow a similar route in the coming months. So far, nearly 6 million Americans have received the drug at the expense of the federal government, but information from HHS suggests that the drug will be paid for via the commercial market by mid-2023.

According to Recht, the federal government initially purchased 20 million courses of Paxlovid at roughly $530 each. While a commercial price has not been announced, it will likely cost much more. Pfizer's Covid-19 vaccine, which the government will also stop paying for next year, is expected to experience a price increase as well.

Will access to Paxlovid be impacted?

According to Chip Davis, CEO of the Healthcare Distribution Alliance, pricing "will become an issue for [entities] that thus far [haven't] been directly involved, which [are] insurers and commercial plans," after Covid-19 vaccines and treatments hit the commercial market.

Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms, said private insurers will likely end up covering Covid-19 treatments to some extent, but there are "really no rules at all" about when or how the drugs will be covered. Some people may face high copays for Covid-19 treatments, much as they do for insulin or other expensive, brand-name drugs.

In addition, while Medicaid is expected to cover Covid-19 treatments in full through at least early 2024, federal law prohibits Medicare Part D from covering Covid-19 treatments that are available only under an emergency use authorization. Pfizer has applied for full FDA approval for Paxlovid, but it is not clear how long it will take for FDA to review and approve the treatment.

"We know from lots of research that when people face cost sharing for these drugs that they need to take, they will often forgo or cut back," Corlette said.

In particular, "[i]f you look at access to medications for people who are uninsured, I think that there's no question that will widen those disparities," said Jill Rosenthal, director of public health policy at the liberal-leaning Center for American Progress. Disparities by race, income, and geography are also likely to increase.

In November, the Biden administration requested $2.5 billion for Covid-19 vaccines and treatments to help people pay for the medications when they're no longer free, but this request is unlikely to be approved by Congress.

"From a public health perspective, and even from a health care capacity and cost perspective, it would just defy reason to not continue to make these drugs readily available," said Larry Madoff, medical director of Massachusetts' Bureau of Infectious Disease and Laboratory Sciences.

Although these Covid-19 treatments may be expensive, they are much cheaper than a hospital stay if a patient ends up severely ill. "The medications are so worthwhile," Madoff said. "They're not expensive in the grand scheme of health care costs." (Recht, Kaiser Health News, 12/7)