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Medicare Minutes: Paxlovid Remains Free for Medicare Recipients

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The Department of Health and Human Services (HHS) reminds provider groups that patients should not pay the total out-of-pocket cost for oral antivirals that treat COVID-19, such as Paxlovid, as the products transition to the commercial marketplace.

HHS and Pfizer met to speak about “the pathways for a smooth transition of oral antivirals for COVID-19, including Paxlovid, to the commercial market and the importance of provider education and clear communication to consumers,” according to an HHS statement.

The supply of government-purchased Paxlovid is still being used and distributed. However, the majority of the drug supplies currently on the market are purchased commercially.

HHS officials emphasized that patients should not pay the total cost of Paxlovid regardless of insurance status. In an agreement Pfizer signed with HHS, all patients on Medicare or Medicaid will be allowed access to Paxlovid for free through the end of 2024 and maintain access for uninsured patients through the end of 2028.

HHS also met with pharmacies and insurance companies. All this effort comes just as a recent study found that providers failed to give two-thirds of eligible patients prescriptions for Paxlovid.  Emergency room visits had five times lower odds of treatment, and COVID-19 testing done through a lab found no apparent follow-up with patients to inform them of positive results.

Doctors, nurses, pharmacists, and other health care professionals need to be more educated about the benefit-risk trade-off of Paxlovid. Potential side effects are minor compared with the prospect of severe disease from COVID-19, and most drug interactions can be managed.

HHS said providers should ensure patients understand the range of options for accessing Paxlovid and, if they have difficulty with payment, should be directed to Pfizer’s patient assistance program, PAXCESS. The information available through the PAXCESS website includes resources for prescribers, drug interactions, and locations where patients can find Paxlovid. Patients can also call the hotline at 877-219-7225 to get help obtaining Paxlovid.