A pharmacist delivers a COVID-19 booster dose at a Chicago CVS store in October.
Antonio Perez | Tribune News Service | Getty Images
The US will stop buying discounted Covid shots for the entire country and shift vaccine distribution to the private market early in the fall, shifting the cost onto US insurers and uninsured Americans who might lose access to free vaccines.
doctor. Ashish Jha, the White House Covid response coordinator, said in an interview with the University of California, San Francisco’s Department of Medicine on Thursday that the shift to a private market would happen during the summer or early fall, though no specific date was given.
Fall would be a natural time to move into a private market, a senior official with the Department of Health and Human Services told CNBC, especially if the Food and Drug Administration selects a new Covid strain for vaccines and requires manufacturers to produce updated shots in the future. of the respiratory virus season.
Over the past two years, the United States has bought vaccines directly from Pfizer And accident At an average price of about $21 a dose, according to the Kaiser Family Foundation.
The federal government has required pharmacies, doctors’ offices, and hospitals to provide these shots for free to everyone, regardless of their insurance status.
If you have health insurance
When the federal Covid vaccination program ends, the shots will still be free for people with health insurance due to requirements under the Affordable Care Act.
But uninsured adults may have to pay for vaccinations when this happens Pfizer And accident Start by selling the shots on the private market as existing Federal stock runs out. There is a federal program to provide free vaccines to children whose families or caregivers cannot afford the shots.
Jha said on Tuesday that the planned switch is not linked to the end of the Covid public health emergency in May.
“The end of PHE does not mean that people will suddenly not be able to get the vaccines and treatments they need,” Jha wrote in a tweet on Tuesday.
When the federal government doesn’t buy vaccines at a discount for the entire nation, individual healthcare providers will buy the shots from vaccine makers at a higher price.
Moderna CEO Stéphane Bancel told CNBC last month that the company is preparing to sell vaccines on the private market as early as this fall. Pfizer CEO Albert Bourla told investors during the company’s earnings call this week that he’s preparing to start commercial vaccines in the second half of the year.
Pfizer and Moderna have said they are considering raising the price of vaccines to around $110 to $130 a dose once the US government withdraws from the vaccine program.
If you are not insured
“If you’re not insured, you could face the full cost,” said Cynthia Cox, an expert on affordable care law at the Kaiser Family Foundation.
But the United States still has a large stockpile of free vaccines left. Last year, the Biden administration ordered 171 million Omicron boosters. About 51 million boosters have been administered to date, according to the Centers for Disease Control and Prevention.
The uninsured will continue to get 120 million doses for free, but it’s unclear how long the supply will last.
“With our supply of vaccines and antivirals, we don’t think we will be in a state of rapid transition to project this onto market partners,” the HHS official said.
Although vaccine makers are preparing to sell shots on the private market later this year, the federal stockpile of free shots will likely last longer than that because vaccine uptake has been low, Cox said.
“Everyone in the United States, regardless of their citizenship or insurance status, is able to get a free vaccine as long as this federal stockpile lasts,” Cox said.
senator. Bernie Sanders, I-Vt. He raised vaccine prices in a letter to the CEO of Moderna last month. Sanders, who chairs the Senate Health Committee, said the price hike would cost taxpayers billions of dollars through its impact on the Medicaid and Medicare budgets.
“Perhaps more importantly, a fourfold price hike would make the vaccine unavailable to the millions of uninsured and underinsured Americans who would not be able to afford it,” Sanders said. “How many of these Americans will die from Covid-19 as a result of limited access to these life-saving vaccines?”
Jha said this week that the Biden administration is committed to helping the uninsured gain access to Covid shots and treatments.
“We’re creating a whole separate set of efforts for the uninsured because the uninsured, of course, wouldn’t be able to get vaccines for free and treatments for free under the normal insurance system by definition,” Jha said Thursday. “We’re working on a plan for that.”
One of the tools the federal government plans to use, the HHS official said, is a program called Section 317 that provides funding to purchase and administer shots to uninsured adults at no cost.
But for the vast majority of people with private insurance, the Affordable Care Act will cover the cost of vaccines. Under the ACA, private health insurance is required to cover all immunizations recommended by the CDC at no cost to the consumer.
Medicare will cover vaccines for seniors, who are at higher risk of contracting the virus, and low-income people can get vaccinated through Medicaid.
Cox said there may be a few legacy private health insurance plans by the ACA that are not required to cover Covid vaccines. The HHS official said most of these plans will likely pay for the shots.
In addition, some short-term insurance policies may not pay for vaccines, Cox said. These plans were expanded during the Trump administration and are not required to comply with the ACA.
Cox said the ACA also allows private insurance to limit vaccine coverage to in-network providers. She said that people who used to get vaccinated at any pharmacy during the pandemic may have to go to a specific pharmacy in the future to get a free injection.
Cox said consumers could also see their health insurance premiums increase if Pfizer and Moderna raise the price of their shots.
Paxlovid may not be free
Some patients may also, depending on their insurance policy, have to pay for Pfizer’s Paxlovid antiviral pills in the future. Unlike preventive services such as vaccinations, the ACA does not require insurance to cover treatments.
Bourla told market analysts this week that Pfizer expects to start selling Paxlovid through the private market at commercial prices in the second half of 2023.
Pfizer has not announced how much the drug will cost once it’s commercially available. The federal government pays about $530 for a five-day course of treatment. It’s unclear how much patients will have to pay out of pocket and how much the rate insurance will cover.
Don O’Connell, who heads the federal office responsible for US stockpiles, said last August that the Department of Health and Human Services expects to run out of paxlovid by the middle of 2023.
Jha said on Tuesday that there are still millions of doses of Baxlovid and Omicron in the US stockpile. “They will continue to be freely available to all Americans who need them,” Jha said of the remaining federal supplies.