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Are COVID Treatments Still Free?

How to cover drug costs now that Uncle Sam is no longer footing the bill for everyone 


spinner image a retro illustration of a red COVID-19 spike virus cell next to a blue pill symbolizing Paxlovid and other anti-viral treatments for COVID-19

Respiratory illnesses are surging throughout much of the U.S., and COVID-19 is right in the mix. Data from the Centers for Disease Control and Prevention (CDC) shows that COVID-19 hospitalizations are increasing; so are deaths from the disease — all while new and highly contagious variants are spreading across the globe.

With the concerning trends, doctors and health experts are reminding patients who test positive for COVID-19 that there are prescription treatments that can help keep a mild infection from turning severe.

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“So it's important that everyone who's infected and who is in a high-risk status have access to these medications,” says William Schaffner, M.D., an infectious disease specialist and professor of medicine at Vanderbilt University School of Medicine in Nashville.

However, universal access to free COVID-19 treatments ended on Nov. 1, 2023, when the medications transitioned from the public market to the private one; the federal government is no longer footing the bill for everyone. Instead, patients need to rely on some combination of private insurance, public insurance and assistance programs run by drugmakers to help cover the cost of once-free medications like Paxlovid.

For some people, this shift in coverage bears little to no immediate impact. For others, treating COVID-19 could now come with hoops to jump through and out-of-pocket expenses. It all depends on the type of health insurance you have, explains Jennifer Kates, senior vice president and director of the Global Health & HIV Policy Program at KFF.

Here's what you need to do if you test positive for COVID-19 and are eligible for time-sensitive treatments.

Who will have to pay for COVID treatments?

If you have Medicare or Medicaid or other government insurance

Paxlovid, the most commonly used oral antiviral, will continue to be free through 2024 for people with Medicare or Medicaid through a U.S. government patient assistance program operated by the drug’s maker, Pfizer.

Patients with a prescription for Paxlovid can enroll in the assistance program online at paxlovid.iassist.com or over the phone (1-877-219-7225). Pfizer estimates that the enrollment process takes about five minutes, and it can be done by the patient, a caregiver, a health care provider or a pharmacist at the point of care.

The enrollment form will ask for the basics — name, date of birth, address, phone number and so on. You will also need to enter prescriber information and confirm your insurance status, so if someone else is doing the enrollment for you, be sure they have this information. After enrolling, the patient will receive an electronic voucher that can be exchanged for a free course of Paxlovid at participating pharmacies.

Pfizer tells AARP that as of Jan. 2, approximately 55,000 pharmacies are participating in the government-supported patient assistance program, and that number is expected to grow. This includes retail chains such as CVS, Walgreens, Walmart, Kroger, Costco and several others. If there isn’t a participating pharmacy nearby or if the pharmacy is out of Paxlovid, overnight shipping to the patient’s home will be available, Pfizer says.

Patients who enroll in the program will remain enrolled through Dec. 31, 2024, and will be able to receive more than one prescribed treatment course of Paxlovid throughout the year, Pfizer tells AARP, should you catch COVID-19 more than once in 2024.

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Alternatively, people with Medicare Part D can choose to use their prescription drug plans to acquire oral antiviral COVID-19 treatments, a spokesperson for the Centers for Medicare & Medicaid Services says. Out-of-pocket costs, if any, will vary by plan. CMS says it “has encouraged Part D sponsors to conduct an expedited review of oral antivirals for COVID-19 released commercially on the market and add at least one oral antiviral for COVID-19 that meets the definition of a Part D drug to their formulary on a preferred or $0 cost-sharing tier, as available in the plan benefit structure.” HHS says that if a Part D enrollee has trouble obtaining Paxlovid coverage, they should contact their plan or 1-800-MEDICARE for assistance.

People who get health care through the Indian Health Service, the Department of Veterans Affairs and the Department of Defense will continue to be able to access for free a supply of Paxlovid stockpiled by the federal government, the Department of Health and Human Services (HHS) says.

What happens after 2024 for individuals with Medicare, Medicaid and other government insurance programs remains to be seen.

There isn’t a similar government program in place for Lagevrio, according to the drug’s manufacturer, Merck. Lagevrio, another oral antiviral for COVID-19, is available under an Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) and is a treatment option for people who are unable to take Paxlovid or, if hospitalized, Veklury (remdesivir), both of which are FDA-approved.

Merck says it is offering a patient assistance program for “eligible patients who, without assistance, could not otherwise afford the product.” It takes about 10 to 20 minutes to determine a patient’s eligibility for this program; more information is available at merckhelps.com or by calling 1-800-727-5400.

What about Veklury?

Veklury (remdesivir) is another COVID-19 antiviral treatment, but unlike Paxlovid and Lagevrio, it’s not a prescription pill you take at home. The medication is administered through an IV at a medical facility, and therefore, is covered by Part B for people with Medicare. If you have commercial insurance, coverage and out-of-pocket costs for Veklury will vary by plan.

If you have private insurance

You could face some out-of-pocket costs for treating COVID-19 if you have private insurance, Kates says, since Paxlovid and Lagevrio will “be subject to the regular cost-sharing policies” of your health plan.

That’s because “federal law does not require commercial plans to cover all possible COVID-19 treatments or put any limits on patient cost-sharing for any commercial plans if the treatments are covered,” according to HHS.

Pfizer has priced Paxlovid at $1,390 for the five-day treatment course. However, if your plan doesn’t cover Paxlovid or if your out-of-pocket payment is high, you may be eligible to receive assistance through Pfizer’s copay program, which involves an enrollment process that is similar to the government-backed patient assistance program.

To enroll in the copay program, visit paxlovid.iassist.com or call 1-877-219-7225. (Your doctor may also have copay cards to distribute, so it’s always a good idea to check with your provider first.) And similar to the government-backed patient assistance program, patients who enroll in Pfizer’s copay program can take advantage of it more than once over the course of the year. 

HHS said in a October announcement that it expects there to be commercial coverage for Lagevrio as well. It’s priced at $950 for a treatment course. 

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If you don’t have insurance 

You shouldn’t have to pay out of pocket for treatment in the next few years if you’re uninsured. Paxlovid will remain free for people without health insurance through 2028, and beginning in 2025 it will be free for people who are underinsured, also through 2028, according to an October 2023 HHS news release.

You’ll need to enroll in the patient assistance program to get the antiviral at no cost. More information is available at paxlovid.iassist.com or by calling 1-877-219-7225.

Similarly, Merck’s patient assistance program is meant to help eligible individuals who can’t otherwise afford the full cost of the medication. More information is available at merckhelps.com or by calling 1-800-727-5400.

Hoops, hiccups a concern for patients 

It’s not unusual for drug coverage transitions to come with a few glitches. But any wrinkles are a particular worry when it comes to COVID-19 treatments, health experts say, since timely access to the antivirals is key.

The medications work best when started right away — within five days of the onset of symptoms. Any delays due to cumbersome copay programs or confusion over coverage could risk a person’s ability to benefit from the treatment, Kates says.

“If it creates any holdups or backups, which does happen in the health care system, that could mean the difference between being able to access this medication that is highly important for some people, and not getting it,” Kates says.

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Schaffner adds, “The more elaborate the process is to get access to the medication, the more difficult it will be for people.”

Recent research highlighted by HHS finds that oral antiviral treatments can reduce COVID-19 hospitalizations and deaths by as much as tenfold for people at high risk for severe disease. This population includes adults 50 and older and people with any number of underlying health conditions including diabetes, heart disease and obesity.

While trends have drastically improved since previous pandemic peaks, nearly 30,000 people were hospitalized with COVID-19 the week of Dec. 17-23 in the U.S., according to federal data. The rate of hospitalizations and deaths among older adults continues to tower over younger age groups.

“COVID is still a problem," says Mariana Socal, M.D., associate scientist in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, “especially for the most clinically vulnerable individuals.” 

Experts urge patients to be proactive 

The advice from health experts is to be proactive — especially at a time when respiratory virus activity levels are soaring in many areas of the country.

Talk to your health care provider about whether you’re a good candidate for Paxlovid or Lagevrio, should you come down with COVID-19, Socal says. And you don’t need to wait for a positive test to start that conversation, says Jodie Guest, a professor and senior vice chair in the department of epidemiology at Emory University’s Rollins School of Public Health. If you’ve had a known exposure and are at high risk for a severe case of COVID-19, reach out and get the discussion going, Guest says.

Make sure you have COVID-19 tests on hand, Socal adds, so that if you experience symptoms you can quickly test yourself for the disease, and if positive, pursue prescription treatment.  (You can order four free at-home tests from the government at covid.gov/tests.)

If you have symptoms but test negative for COVID-19, it’s important to still talk to your doctor, Schaffner says. You may have the flu, which shares similar symptoms with COVID-19, and there are different antiviral treatments for that.

“It is common for people to say, ‘Well, I'll see if I get better tomorrow.’ And so they put things off, and of course, that allows the infection to continue,” Schaffner says. “We ought to overcome that reluctance and contact our providers early rather than later.”

Editor's note: This story, first published Nov. 1, 2023, has been updated to include new information.

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