Paxlovid has been free so far. Looking forward to Sticker Shock next year.

about 6 million Americans have taken paxlowid For free, courtesy of the federal government. Pfizer’s pill has helped save many people from getting infected COVID-19 being hospitalized or dying, and it may also reduce the risk of developing long covid, But the government plans to close the bill within months, and millions of people who are at highest risk of serious illness and least able to afford the drug — the uninsured and seniors — could end up paying the full price.

And that means fewer people will get 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. She said a bill of several hundred dollars or more would lead many people to decide the drug isn’t worth the price.

In response to the unprecedented public health crisis caused by COVID, the federal government spent billions of dollars on developing new vaccines and treatments, to rapid success: less than a year after the pandemic was declared, medical workers Got the first vaccine. But as many people have refused to get shots and stopped wearing masks, the virus is still raging and mutates, In 2022 alone, 250,000 Americans are expected to die from COVID, more than from stroke or diabetes.

But soon the Department of Health and Human Services will stop supplying COVID treatment, and pharmacies will buy and bill for them in the same way they do for antibiotic pills or asthma inhalers. Paxlovid is expected to hit the private market in mid-2023, according to HHS plans shared in an October meeting with state health officials and physicians. Merck’s Lageverio, a less effective Covid treatment pill, and AstraZeneca’s Evushield, a preventive therapy for immunodeficiency, are on track for commercialization soon, sometime in the winter.

The antiviral drug Paxlovid may reduce the risk of severe illness or death from COVID-19.

Chris Sweda/Chicago Tribune/Tribune News Service via Getty Images

The US government has so far bought 20 million courses of Paxlovid, which cost about $530 apiece, a discount to buy in bulk that Pfizer CEO Albert Bourla called “really very attractive” to the federal government in a July earnings call. The price of the drug in the private market would be much higher, although in a statement to KHN, Pfizer declined to share the planned price. government will also Stop Paying for the Company’s COVID Vaccine Next year — the cost of those shots will quadruple, from the discount rate the government pays from $30 to about $120.

Bourla told investors in November that he expected the move to make Paxlovid and its Covid vaccine “a multi-billion dollar franchise.”

Nearly 9 out of 10 people who die from the virus are now 65 or older. Yet federal law prohibits Medicare Part D — the prescription drug program that covers about 50 million seniors — from covering COVID treatment pills. The drugs are for those at highest risk of serious illness, including seniors.

Paxlovid and other treatments are currently available under an emergency use authorization from the FDA, a fast-track review to be used in exceptional situations. Although Pfizer applied for full approval in June, the process could take several months to years. And Medicare Part D can’t cover any drug without a full stamp of approval.

Federal health experts wrote that out-of-pocket payments would be a “substantial obstacle” for seniors on Medicare — the same people who would benefit most from the drug.

“From a public health perspective, and even from a health care efficiency and cost perspective, it would just make sense not to make these drugs readily available,” Dr. Larry Madoff, medical director of the Massachusetts Bureau of Infectious Diseases he said. Laboratory Science. He hopes the federal health agency will find a way to set aside unused doses for seniors and those without insurance.

In mid-November, the White House requested that Congress approve an additional $2.5 billion for COVID therapeutics and vaccines to ensure people can afford the drugs when they are no longer free. But there is little hope that it will be approved – the Senate voted on the same day to end the public health emergency and has denied similar requests in recent months.

Many Americans already face barriers to obtaining prescription-only treatments for COVID treatment. Although the federal government doesn’t track who received the drug, a Centers for Disease Control and Prevention study using data from 30 medical centers found black and Hispanic patients with Covid were more likely to receive paxolovid than white patients. The chances were slim. (Hispanic people can be of any race or combination of races.) And while the government is no longer picking up the tab, experts predict that these gaps will widen based on race, income and geography.

According to a KHN analysis of Paxlovid use in September and October, people in the northeastern states used the drug far more frequently than in the rest of the country. But that wasn’t because people in the region were getting sick from COVID at much higher rates — instead, many of those states offered better access to health care to begin with and their residents to get Paxlovid. Make special programs.

About 10 mostly Democratic states and several large counties in the Northeast and elsewhere have created free “test-to-treat” programs that provide their residents with immediate doctor visits and prescriptions for treatment after testing positive for COVID. Let’s allow. In Massachusetts, more than 20,000 residents have access to the state’s video and phone hotline, which is available in 13 languages, seven days a week. Massachusetts, which has one of the highest insurance rates in the country and relatively short travel times to pharmacies, had the second-highest Paxlovid use rate among states this fall.

States with higher COVID 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. Without free test-to-treat options, residents have struggled to obtain prescriptions, while the drug is still free.

“If you look at access to drugs for people who are uninsured, I think there’s no question those disparities will widen,” Rosenthal said.

People who get insurance through their jobs may also face higher copayments at the register, just as they do for insulin and other expensive or brand-name drugs.

Most private insurers will cover COVID therapeutics to some degree, said Sabrina Corlett, research professor at Georgetown University’s Center on Health Insurance Reforms. After all, pills are cheaper than a stay in the hospital. But for most people who get insurance through their jobs, “there really are no rules,” she said. It can take months for some insurers to decide whether to include the drugs in their plans or not to pay for them.

And the added cost means many more people will be left without the drug. “We know from a lot of research that when people are faced with cost sharing for these drugs, they will often withdraw or cut back,” Corlett said.

A group doesn’t need to worry about sticker shock. Medicaid, the public insurance program for low-income adults and children, will cover the treatment in full until at least early 2024.

HHS officials may set aside any remaining taxpayer-funded drugs for those who can’t pay the full cost, but they haven’t shared any concrete plans to do so. The government bought 20 million courses of Paxlovid and 3 million courses of Lagevrio. Less than a third have been used, according to KHN’s analysis of HHS data, and use has declined in recent months.

Sixty percent of the government’s supply of Evusheled is still available, although the COVID prevention medicine is less effective against new strains of the virus. In one state, New Mexico, the health department has recommended against its use.

HHS did not make the officials available to interview or answer written questions about the commercialization plans.

The government devised a possible solution this summer by moving another COVID treatment, bebtelovimab, to the private market. It now retails for $2,100 per patient. The agency set aside the remaining 60,000 doses purchased by the government, which hospitals can use to treat uninsured patients in a complex dose-substitution process. But it’s hard to tell how well that setup will work for Paxlovid: Bebetalovimab was already much less popular, and the FDA halted its use on Nov. 30 because it’s less effective against the current strain of the virus.

Federal officials and insurers will have good reason to ensure patients can continue to afford COVID drugs: They’re much cheaper if patients wind up in the emergency room.

“The drugs are very worthwhile,” said Madoff, the Massachusetts health official. “They are not that expensive in the grand scheme of health care costs.”

KHN (Kaiser Health News) is a national newsroom that does in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operational programmes. kff (Kaiser Family Foundation). KFF is a thriving non-profit organization that provides information on health issues to the nation.

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