The price of the lifesaving Covid-19 medication Paxlovid is likely to rise next year for most patients as the United States continues to transition out of the emergency phase of the pandemic, sparking concerns among doctors that it will become less accessible.
Just as with Covid-19 vaccines this season, the antiviral \u2013 a combination of the drugs nirmatrelvir and ritonavir \u2013 will move from being available free to everyone through government purchases to a more traditional commercial marketplace for most patients at the end of this year, according to the US Department of Health and Human Services and drugmaker Pfizer.
The new price \u2013 the cost before insurance \u2013 hasn\u2019t been set but is expected to be higher than the $530-per-course price paid by the US government.
People who are on Medicare or Medicaid or who are uninsured will still be able to get Paxlovid for free through 2024 via a patient assistance program, according to HHS, but those with commercial insurance are likely to face a copay, Pfizer Chief Executive Albert Bourla said Monday. About 40% of prescriptions of Paxlovid are written for Medicare and Medicaid patients, he said.
\u201cWe are starting negotiations with payers,\u201d Bourla told analysts and investors on a company conference call. The \u201cpandemic price\u201d paid by the US, he said, is likely to be \u201clesser\u201d than the new commercial price.
One financial analyst who follows the company, Evercore ISI\u2019s Umer Raffat, suggested that the price could go up three- to fivefold, to as much as $2,500 per course.
Dr. Eric Topol, a professor of molecular medicine at Scripps Research, called the potential plans for a price increase \u201cmore bad news of price gouging by Pfizer.\u201d
\u201cLess people who need Paxlovid will get it \u2013 whether it\u2019s because of lack of insurance, or concerns about payment\/co-pay,\u201d Topol wrote in an email. \u201cEven for those who have full coverage, sticking it to insurers just winds up, in the long run, increasing health care insurance premiums for all.\u201d
Infectious disease physicians shared Topol\u2019s concern about people\u2019s ability to get the medication.
\u201cThere\u2019s no doubt that cost is a major factor in determining access to medication in the United States,\u201d said Dr. Paul Sax, clinical director of the Infectious Disease Clinic at Brigham and Women\u2019s Hospital and a professor of medicine at Harvard Medical School. He noted that insurance plans vary widely in coverage and how much people have to pay out of pocket.
\u201cThe higher these costs are,\u201d he said, \u201cthe more likely people are to forego treatment.\u201d
A Pfizer spokesman said that the company plans to share information about pricing \u201cin the coming weeks\u201d and that \u201cPaxlovid has and will continue to provide value to eligible patients, providers, and health care systems due to its important role in helping reduce Covid-19-related hospitalizations and deaths among people who are at high risk for progression to severe illness.\u201d
Because the medication has been shown to reduce the risk of severe disease and death from Covid-19 among vulnerable groups, access is crucial even as the virus recedes from the forefront of everyday life, said Dr. Paul Offit, a professor of pediatrics in the Division of Infectious Diseases at Children\u2019s Hospital of Philadelphia.
\u201cThis virus isn\u2019t over,\u201d he said, noting that it\u2019s likely to circulate for decades. \u201cThose who are at highest risk of severe illness need to make sure that if they have an upper respiratory tract infection that they test themselves, and if they\u2019re positive very early on in the course of that illness, they need to take Paxlovid to save their life.\u201d
Paxlovid is available by prescription and should be taken in the first five days of symptoms.
Covid-19 appears to be in a downturn in the US after hospital admissions related to the virus peaked in early September. Previous years have similarly seen increases in late summer, typically followed by larger waves around the end of the year. It\u2019s not clear which pattern this winter will take, however.
Other serious respiratory viruses are just starting to pick up. Levels of respiratory syncytial virus, or RSV, appear to be low nationally but have picked up in the South, especially in Florida. Levels of flu were still low or minimal in all states except Alaska, where levels were moderate, in the first week of October, according to data from the US Centers for Disease Control and Prevention.
This season is the first with protection available against all three major respiratory viruses \u2013 flu, Covid and RSV \u2013 and the CDC recommends protection against all three for everyone who\u2019s eligible.
Two RSV vaccines were approved this year for adults 60 and older, and an RSV vaccine was approved for use during pregnancy to protect babies early in life. A protective antibody shot for RSV was also approved for babies, which the CDC recommends for all up to 8 months old and for some older babies who are more vulnerable to severe disease.
An updated Covid-19 vaccine designed to protect against recently circulating strains is also available, and the CDC recommends it and the seasonal flu shot for everyone 6 months and older.
Covid-19 vaccines also increased in price once they stopped being provided universally by the US government. Shots from Pfizer, Moderna and Novavax were priced between $15 and $30 in large-volume purchase agreements with the government during the pandemic, and the companies increased the price about fourfold, to $115 to $130 per dose, after the US transitioned out of the system in which the government paid for the shots.
The vaccines are still supposed to be covered by insurance, but some people have been hit with out-of-pocket costs inappropriately in the early days of the fall rollout as insurance coverage through the commercial market settles into place.
Doctors fear that a higher price for Paxlovid could cause problems, as well.
\u201cBy making it more expensive, it just creates a huge hurdle,\u201d Offit said. \u201cDo I think that that will limit uptake? Yes, I do.\u201d<\/p>\n\n\n\n