By Mimi Nguyen Ly
COVID-19 vaccines and treatments that have been free of charge to consumers, due to U.S. government funding, will eventually transition to be provided via the regular health care system.
This means that certain COVID-19 tests, vaccines, and treatments, will cost more for some.
Here’s what it means for you:
End of Emergency
Ashish Jha, the White House COVID-19 response coordinator, said in an interview with UCSF Department of Medicine that when the public health emergency (PHE) ends in May, the emergency use authorizations (EUAs) that have been granted by the U.S. Food and Drug Administration (FDA) to certain COVID-19 treatments and vaccines will not be affected, he said.
“So, if on May 11 when the public health emergency ends, on May 12 you can walk into a CVS, get your bivalent vaccine, and it will be free for you. If you’ve got COVID on May 13, you can get your Paxlovid, it’ll be free. It will be the stuff that the government has bought,” he said on Thursday.
The U.S. government has spent more than $30 billion of taxpayer money on COVID-19 vaccines, including new bivalent boosters, to in part ensure they would be provided free of charge, nonprofit KFF reported in December 2022.
It added that the government “has so far purchased 1.2 billion doses of Pfizer and Moderna COVID-19 vaccines combined, at a cost of $25.3 billion, or a weighted average purchase price of $20.69 per dose.”
But the Biden administration no longer has money to back the effort due to a lack of support from Congress. “This means that manufacturers will be negotiating prices directly with insurers and purchasers, not just the federal government, and prices are expected to rise,” per the KFF.
Jha told the UCSF Department of Medicine: “The U.S. government, in an unprecedented way … bought hundreds of millions of vaccines, lots of treatments, they’re bought with taxpayer money, and we have a bunch and we’re giving it out and we’re distributing it, and these are mostly emergency use products.”
But Congress has not provided further funding to address COVID-19 efforts for “over a year” he said, adding: “It means that we’re going to stock out at some point, that we’re going to run out of government-purchased vaccines and treatments, and we have to move towards a more regular way of delivering vaccines and treatment.
“When is it exactly going to happen? That is going to depend on our stocks. … We don’t have the specific date. It can happen some time over this summer over into early fall,” he said, adding that while the time frame is unclear, the federal government will “give people as much notice as we can.”
Once the transition occurs, anyone with health insurance—whether public or private—will still be able to receive COVID-19 vaccines free of charge. This is because the Affordable Care Act requires that preventative services are available to consumers with no out-of-pocket costs. “Vaccines are preventable services,” Jha noted.
But health insurance companies are not required to cover treatments under the Affordable Care Act. As such, COVID-19 treatments, once it transitions to the regular market, are expected to have some out-of-pocket costs depending on a person’s health insurance coverage.
Paxlovid, an antiviral pill made by Pfizer to treat COVID-19, has been costing the U.S. government about $530 for a five-day treatment course. It is unclear how much Pfizer will charge for a treatment course, and how much health insurance companies will cover for patients.
“Treatments are going to through like the way people get them like they get other medicines. We’re really committed, I’m personally super committed, to making sure that they’re relatively as low as possible out-of-pocket costs,” Jha said. “We’re going to do a bunch of things to try to limit those costs.”
Meanwhile, the uninsured will not be able to obtain vaccines or treatments free of charge.
“We are creating a whole separate set of efforts for the uninsured because the uninsured will not be able to get vaccines for free and treatments for free,” Jha said, adding that the federal government is “working on a plan on that.”
He said no action needs to be taken right away on the matter because COVID-19 vaccines and treatments that the government purchased “will be available for the uninsured and for everybody else for a while.”
As for COVID-19 tests, when the PHE ends, insurance companies will no longer be required to cover the cost of free at-home COVID-19 tests. Under the PHE, insurance companies were compelled to cover eight tests per person per month. “That does come to an end when the public health emergency ends,” Jha said.