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Fact checked by Nick Blackmer
On November 1, COVID-19 drug Paxlovid will be sold commercially for the first time.
Most people will have the drug covered by private or federal insurance. Pfizer will have an assistance program for people who are uninsured or underinsured.
Glitches are expected in the first few days and weeks of the transition as pharmacies bring new insurance data online in order to process Paxlovid prescriptions.
Paxlovid, a drug that can help prevent severe illness and death from COVID-19, has been cost-free for anyone, regardless of health insurance coverage, since it was first authorized in 2021. But that will change on November 1, when the drug moves from the public to the commercial market.
The move is a result of the conclusion of the COVID Public Health Emergency, declared at the start of the pandemic and lifted in May, Priya Nori, MD, an infectious disease specialist at Montefiore Medical Center in New York City, told Verywell.
Pfizer, which makes Paxlovid, has announced that the five-day drug course for Paxlovid will have a retail cost of $1,390 according to reporting by CNBC. Pfizer and the Department of Health and Human Services (HHS), however, have said that the actual cost of the drug for just about all consumers—at least through the end of 2024—is expected to be far lower or even free.
Still, some glitches regarding cost and coverage are expected in the first few days and weeks of the transition. Not all details are available yet, but here is what we know so far.
New Patient Assistance Programs Are Rolling Out
Together, HHS and Pfizer have announced patient assistance programs that will provide Paxlovid for free to people on federal insurance programs such as Medicare and Medicaid until at least the end of 2024. These programs will also cover the cost of the drug for people without insurance and copays for people who are “underinsured”—that is, have a copay they can’t afford.
Federal Insurance Programs
According to HHS, through the end of 2024, people who are uninsured and those who have Medicare or Medicaid coverage will continue to be able to get Paxlovid for free through a patient assistance program set up by Pfizer. That should mean that you pay nothing at the pharmacy counter. If you’re on Medicare or Medicaid, bring your insurance card with you so the pharmacy can verify your coverage.
HHS also says that people who are covered through the Indian Health Service, the Department of Veterans Affairs (VA), and the Department of Defense will continue to get Paxlovid through the supplies purchased by the government. If that applies to you, have your member card on hand and try to fill prescriptions at pharmacies in those program networks—call the member number on your insurance card to find locations.
Copay Assistance for Private Insurance
According to an information sheet from HHS, a Pfizer-sponsored “copay savings program will be available for eligible commercially insured patients,” but there are no details yet on how to access that and Pfizer did not respond to requests for information.
Other Ways to Get Paxlovid for Free or Cheap
While the official cost savings programs get up and running, there are two main methods you may be able to use to get Paxlovid for free quickly. Speed matters; Paxlovid must be taken within five days of COVID symptom onset in order to be effective, Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Verywell.
Ask the pharmacy if they still have government-purchased supplies. Through the end of the year, if you have a prescription for Paxlovid and the pharmacy has supplies they received for free because they were purchased by the U.S. government, they are permitted to dispense the free supply even after November 1. You just need to ask.
Look for pharmacies particpating in Test to Treat. An existing government program for COVID-19 called Test to Treat will continue to dispense Paxlovid and Lagevrio (a slightly less effective antiviral made by Merck) for free at participating pharmacies and community health centers if they have supplies on hand. If you need testing, a vaccine, or have a prescription for Paxlovid or Lagevrio, use this online locator or call 1-800-232-0233 to locate free appointments.
Certain clinical trial participants can get Paxlovid quickly, too. With the help of a testing firm called eMed, the National Institutes of Health (NIH) is running a clinical trial evaluating at-home testing for COVID-19 that includes free Paxlovid if you test positive and are eligible for the drug.
Regardless of insurance status, you can register online for eMed’s Home Test to Treat program at any time and receive six at-home COVID rapid tests if you are accepted. You can also upload the results of a PCR test. In the event of a positive test, you’ll be able to connect with a telehealth provider for free who will determine if you are eligible to take Paxlovid.
If you are eligible for Paxlovid, the physician can send a prescription to a local pharmacy, which may charge a dispensing fee that can range from a few cents to $20, Michael Mina, MD, PhD, chief science officer at eMed, told Verywell. “Patients who qualify for Paxlovid can also have the drug sent overnight with no cost for shipping or the medication,” he added.
Who Is Eligible for Paxlovid?
Only people age 12 and older who are considered at high risk for severe disease from COVID-19 are eligible for Paxlovid. This includes people with underlying health conditions like asthma, diabetes, chronic lung disease, and chronic kidney disease.
Even if you meet these criteria, it’s important to know that many medications are not safe to take alongside Paxlovid. If you need an antiviral treatment but are taking a medication that makes Paxlovid unsafe, you may be prescribed Lagevrio instead.
Rapid Tests Are Barriers to Paxlovid, Too
The current transition to the commercial market is not the only issue that could make it hard for people who might benefit from Paxlovid to access the drug within the five-day eligibility period. A recent study published in the journal Clinical Infectious Diseases found that since so many people have had a COVID vaccine and/or at least one COVID-19 infection, our immune systems are better primed against the disease. An infected person’s viral load might not rise sufficiently enough for them to test positive on an at-home rapid test until the fourth day of symptoms.
But you may also test negative on a COVID test because you don’t have the virus and therefore don’t need Paxlovid. In fact, if you have flu, people at risk of severe illness need different medication, which has to be started within 48 hours of symptoms in order to be effective.
"If somebody is at high risk for severe COVID and has symptoms consistent with COVID, but is testing negative on a home antigen test, I would suggest being tested for other illnesses as well as getting tested for COVID with a PCR, test," Adalja said.
Chris Chao, MD, president of the College of Urgent Care Medicine, told Verywell that the PCR test for COVID-19, a more sophisticated test that you can get at a doctor’s office or clinic, has remained more effective than rapid tests over the course of the pandemic. While results used to take days, they now take just a few hours, “which can lead to a quick Paxlovid prescription if it’s warranted,” Chao said.
What This Means For You
If you’re having trouble getting free or low-cost Paxlovid, know that temporary challenges are expected as the drug becomes commercially available for the first time. Pharmacies and clinics are working to update insurance coverage information.
People with private or federal health insurance are likely to get the drug for free or a small copay if they are eligible for it. If, after November 1, your doctor prescribes Paxlovid and the pharmacy is charging a fee or copay that you can’t afford, you’ll be able to call the company that makes it to ask about assistance programs.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
Read the original article on Verywell Health.