The Atlanta Journal-Constitution

Era of free COVID-19 vaccines, test kits, treatments ending

As public health emergency ends, so will fed subsidies.

- By Julie Appleby Correspond­ent Darius Tahir contribute­d to this report.

Time is running out for freeto-consumer COVID-19 vaccines, at-home test kits, and even some treatments.

T h e White House announced this month that the national public health emergency, first declared in early 2020 in response to the pan- demic, is set to expire May 11. When it ends, so will many of the policies designed to combat the virus’s spread.

Take vaccines. Until now, the federal government has been purchasing COVID shots. It recently bought 105 million doses of the Pfizer-biontech bivalent booster for about $30.48 a dose, and 66 mil- lion doses of Moderna’s version for $26.36 a dose. (These are among the companies that developed the first COVID vaccines sold in the United States.)

People will be able to get these vaccines at low or no cost as long as the govern- ment-purchased supplies last. But even before the end date for the public emergency was set, Congress opted not to provide more money to increase the government’s dwindling stockpile. As a result, Pfizer and Moderna were already planning their moves into the commercial market. Both have indicated they will raise prices, somewhere in the range of $110 to $130 per dose, though insur- ers and government health programs could negotiate lower rates.

“We see a double-digit bil- lion(-dollar) market opportu- nity,” investors were told at a Jpmorgan conference in San Francisco recently by Ryan Richardson, chief strategy offi- cer for Biontech. The company expects a gross price — the full price before any discounts — of $110 a dose, which, Richardson said, “is more than justified from a health eco- nomics perspectiv­e.”

That could translate to tens of billions of dollars in reve- nue for the manufactur­ers, even if uptake of the vaccines

is slow. And consumers would foot the bill, either directly or indirectly.

If half of adults — about the same percentage as those who opt for an annual flu shot — get COVID boosters at the new, higher prices, a recent KFF report estimated, insurers, employers and other payors would shell out $12.4 billion to $14.8 billion. That’s up to nearly twice as much as what it would have cost for every adult in the U.S. to get a biva- lent booster at the average price paid by the federal government.

As for COVID treatments, an August blog post by the Department of Health and Human Services’ Administra- tion for Strategic Prepared- ness and Response noted that government-purchased supplies of the drug Paxlovid are expected to last through mid- year before the private sector takes over. The government’s bulk purchase price from manufactur­er Pfizer was $530 for a course of treatment, and it isn’t yet known what the companies will charge once government supplies run out.

Effect on consumers

One thing is certain: How much, if any, of the boosted costs are passed on to consumers will depend on their health coverage. Medicare beneficiar­ies, those enrolled in Medic- aid — the state-federal health insurance program for people with low incomes — and peo- ple with Affordable Care Act coverage will continue to get

COVID vaccines without cost sharing, even when the public health emergency ends and the government-purchased vaccines run out. Many people with job-based insurance will also likely not face copayments for vaccines, unless they go out of network.

People with limited-benefit or short-term insurance poli- cies might have to pay for all or part of their vaccinatio­ns. And people who don’t have insurance will need to either pay the full cost out-of-pocket or seek no- or low-cost vaccinatio­ns from community clinics or other providers.

Coming up with what could be $100 or more for vaccinatio­n will be especially hard “if you are uninsured or under- insured; that’s where these price hikes could drive additional disparitie­s,” said Sean Robbins, executive vice president of external affairs for the Blue Cross Blue Shield Asso- ciation. Those increases, he said, will also affect people with insurance, as the costs “flow through to premiums.”

Meanwhile, public policy experts say many private insur- ers will continue to cover Paxlovid, although patients may face a copayment, at least until they meet their deductible.

Medicaid will continue to cover it without cost to patients until at least 2024. But Medicare coverage will be lim- ited until the treatment goes through the regular FDA process, which takes longer than the emergency use authorizat­ion it has been marketed under.

Another complicati­on: The rolls of the uninsured are likely to climb over the next year, as states are poised to reinstate the process of regularly determinin­g Medicaid eligibilit­y, which was halted during the pandemic. Starting in April, states will begin reassessin­g whether Medicaid enrollees meet income and other qualifying factors.

An estimated 5 million to 14 million people nationwide might lose coverage.

“This is our No. 1 concern” right now, said John Baackes, CEO of L.A. Care, the nation’s largest publicly operated health plan with 2.7 million members.

“They may not realize they’ve lost coverage until they go to fill a prescripti­on” or seek other medical care, including vaccinatio­ns.

What about COVID test kits?

Rules remain in place for insurers, including Medicare and Affordable Care Act plans, to cover the cost of up to eight in-home test kits a month for each person on the plan, until the public health emergency ends.

A government website is still offering up to four test kits per household, until they run out.

Starting in May, though, beneficiar­ies in original Medicare and many people with private, job-based insurance will have to start paying outof-pocket for the rapid antigen test kits. Some Medicare Advantage plans, which are an alternativ­e to original Medi- care, might continue covering them without a copayment.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organizati­on providing informatio­n on health issues to the nation.

 ?? CHRISTINA MATACOTTA FOR AJC FILE 2022 ?? Pharmacist Ira Katz prepares a vaccine for a customer in Little Five Points Pharmacy in Atlanta. COVID-19 treatment medication­s face private-sector pricing as federal supplies run out.
CHRISTINA MATACOTTA FOR AJC FILE 2022 Pharmacist Ira Katz prepares a vaccine for a customer in Little Five Points Pharmacy in Atlanta. COVID-19 treatment medication­s face private-sector pricing as federal supplies run out.

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