Since early in the pandemic, the federal government has provided COVID-19 testing, drug treatment, and vaccines free of charge to everyone in the United States. But by mid-2023, these tests and treatments will start to be privatized, leaving the public's access to COVID-19 control measures in the hands of manufacturers and health insurers.
Already, the government program that reimbursed health care facilities for COVID-19 testing for people without health insurance has stopped accepting new claims, and Eli Lilly's COVID-19 monoclonal antibody treatment is only available on the commercial market.
The two mRNA COVID-19 vaccines, made by Pfizer/BioNTech and Moderna, will continue to be provided free to Medicare recipients, but Medicare will have to pay more for them. Pfizer has announced plans to raise its price to the government from about $30 per dose to $110 to $130 each. Moderna expects to charge Medicare $60 per dose for its COVID-19 vaccines, up from the previous price to the government of $16.50.
Until now, the COVID-19 treatment that combines nirmatrelvir tablets with ritonavir tablets, sold by Pfizer as Paxlovid, was available to the U.S. government for about $530 for each course of treatment. Pfizer has not yet released its new price, but it is expected to be significantly higher on the commercial market.
Because Paxlovid so far has only been given emergency use authorization from the Food and Drug Administration (FDA), Medicare Part D is barred by federal regulations from covering it. Pfizer applied last June for full authorization, a review process that can take several months. However, Medicaid will continue to cover the cost of Paxlovid at least through 2024. Without full FDA approval, Paxlovid also can't be sold commercially, though the company's confidence in obtaining that approval is evident in its launch of direct advertising to consumers.
Advocates warn that ending federal support for COVID-19 vaccines, drugs, and testing could leave vulnerable populations-especially those without health insurance-at risk for illness and preventable death. Even people with employment-based or other private health insurance could face hardship since costs are likely to vary widely, depending on each insurance plan's deductibles, copayments, and out-of-pocket caps. The well-documented disparities in access to COVID-19 prevention and treatment measures due to race, income, and geography are also expected to worsen. Anticipating these problems, the Biden administration requested funds to support those who can't afford the new charges, but Congress denied his request last November.-Betsy Todd, MPH, RN