The US plans to stop buying Covid shots this fall. What does it mean
A pharmacist delivers a booster dose of COVID-19 at a CVS store in Chicago in October.
Antonio Perez | Tribune News Service | Getty Images
The U.S. will stop buying discounted Covid vaccines nationwide and move vaccine distribution to the private market as early as early fall, passing the cost on to U.S. insurers and uninsured Americans who could lose access to free vaccines.
Dr. Ashish Jha, the White House’s Covid Response Coordinator, said in an interview with the UCSF Department of Medicine on Thursday that the transition to the private market will happen in the summer or early fall, though no exact date has been set.
A senior official from the Department of Health and Human Services told CNBC that autumn would be a natural time to move to the private market, especially if the Food and Drug Administration chooses a new strain of Covid for vaccines and asks manufacturers to prepare updated shots in advance. season of respiratory viruses.
For the past two years, the United States has purchased vaccines directly from pfizer And Art Nouveau at an average price of about $21 per dose, according to the Kaiser Family Foundation.
The federal government requires pharmacies, doctors’ offices, and hospitals to provide these shots free of charge to anyone, regardless of insurance status.
If you have health insurance
When the federal Covid vaccination program ends, vaccinations will remain free for people with health insurance, as required by the Affordable Care Act.
But uninsured adults may have to pay for their own vaccinations when pfizer And Art Nouveau start selling shots on the private market and the current federal stock will run out. There is a federal program Provide free vaccines for children whose families or caregivers cannot afford vaccinations.
Jha said on Tuesday that the planned transition is unrelated 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 tweeted on Tuesday.
When the federal government stops buying nationwide discounted vaccines, individual health care providers will buy shots from vaccine manufacturers at a higher price.
Moderna CEO Stephane Bancel told CNBC last month that the company is gearing up to sell vaccines to the private market as early as this fall. Pfizer CEO Albert Burla told investors during the company’s earnings call this week, he revealed that vaccines would be released to the market in the second half of the year.
Pfizer and Moderna said they are considering raising the price of vaccines to around $110-$130 per dose after 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 Affordable Care Law expert at the Kaiser Family Foundation.
But there is still a significant supply of free vaccines in the US. 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 still have access to these 120 million doses for free, but it’s unclear how long the supply will last.
“With the supply of vaccines and antiviral drugs we have, we don’t think we will be in a state of abrupt transition to abandon this from market partners,” an HHS spokesman said.
While vaccine makers are gearing up to sell shots on the private market later this year, Cox said it’s possible that the federal stockpile of free vaccines could last longer as demand for boosters has been low.
“Everyone in the US, regardless of citizenship status or insurance status, can get a free vaccine as long as this federal supply lasts,” Cox said.
Sen. Bernie Sanders, of Virginia, criticized the vaccine price increase in a letter to Moderna’s CEO last month. Sanders, who will chair the Senate Health Committee, said the price increase would cost taxpayers billions due to its impact on Medicaid and Medicare budgets.
“Perhaps most importantly, a quadrupling of prices would put the vaccine out of reach for the millions of uninsured and underinsured Americans who can’t afford it,” Sanders said. “How many of these Americans will die from Covid-19 as a result of limited access to these lifesaving vaccines?”
Jha said this week that the Biden administration is committed to helping the uninsured gain access to Covid vaccinations and treatments.
“We are creating a whole separate set of efforts for the uninsured, because the uninsured, of course, will not be able to receive free vaccines and treatment under the regular insurance system by definition,” Jha said on Thursday. “We are working on a plan for that.”
An HHS official said one of the tools the federal government is planning use a program called Section 317 This provides funding to purchase and administer vaccines to uninsured adults at no cost.
AKA requirements
But for the vast majority of people with private insurance, the Affordable Care Act will cover the cost of vaccines. According to the ACA, private health insurance must cover all vaccinations recommended by the CDC at no cost to the consumer.
Medicare will cover immunizations for older people who are most vulnerable to the virus, and low-income people can get the vaccine through Medicaid.
There may be a small number of outdated pre-ACA private health plans that are not required to cover Covid vaccines, Cox said. An HHS official said most of these plans will likely pay for the shots.
In addition, some short term insurance politics may not pay for vaccines, Cox said. These plans were created during the Trump administration and are not required to comply with the ACA.
The ACA also allows private insurance to limit vaccine coverage to in-network providers, Cox said. People who are used to being vaccinated at any pharmacy during a pandemic may have to go to a specific pharmacy in the future to get a free shot, she said.
Consumers could also face increased health insurance premiums if Pfizer and Moderna raise vaccine prices, Cox said.
Paxlovid may be paid
Some patients, depending on their insurance policy, may also have to pay for Pfizer Paxlovid antiviral pills in the future. Unlike preventive services such as vaccines, ACA does not require insurance to cover treatment costs.
Burla 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 antiviral will cost once it goes on sale. The federal government pays about $530 for a five-day course of treatment. It is not clear how much patients will have to pay out of pocket and how much of the cost will be covered by insurance.
Don O’Connell, head of the federal agency responsible for US reserves, said last August that the Department of Health and Human Services expects Paxlovid to end by mid-2023.
Jah said on Tuesday that there are still millions of doses of Paxlovid and Omicron boosters in US stockpiles. “They will continue to be available free of charge to all Americans who need them,” Jah said of the remaining federal supplies.
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