The US plans to stop buying Covid shots for the public this fall. Here’s what that means for you
A pharmacist dispenses 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 Covid vaccines at a discounted price nationwide and move vaccine distribution to the private market once early fall begins, shifting costs to U.S. insurers and uninsured Americans who lack access to the free vaccines are in danger of losing out.
Dr. Ashish Jha, the White House Covid response coordinator, said in an interview with the UCSF Department of Medicine on Thursday that the shift to a private market will occur in the summer or early fall, though no exact date has been set.
A senior Health and Human Services official told TBEN that the fall would be a natural time to transition to a private market, especially if the Food and Drug Administration selects a new Covid strain for the vaccines and asks the manufacturers. to take pre-updated shots of the respiratory virus season.
For the past two years, the US has been buying the vaccines directly from Pfizer And Moderna at an average price of about $21 per dose, according to the Kaiser Family Foundation.
The federal government has required pharmacies, doctor’s offices, and hospitals to provide these injections free of charge to anyone, regardless of their insurance status.
If you have health insurance
When the federal Covid vaccination program ends, vaccinations will remain free for people who have health insurance due to requirements under the Affordable Care Act.
But uninsured adults may have to pay for their vaccinations when Pfizer And Moderna start selling the shots on the private market and the current federal supply will run out. There is a federal program to provide free vaccines to children whose families or caregivers cannot afford the injections.
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 no longer be able to get the vaccines and treatments they need,” Jha wrote in a Twitter thread on Tuesday.
When the federal government stops buying discounted vaccines nationwide, individual health care providers will buy the injections from the vaccine makers at a higher price.
Stephane Bancel, CEO of Moderna, told TBEN last month that the company is preparing to start selling the vaccines to the private market as early as this fall. Albert Bourla, CEO of Pfizer, told investors this week during the company’s earnings call that he is preparing to commercialize the vaccines in the second half of the year.
Pfizer and Moderna have said they are considering raising the price of the vaccines to somewhere around $110 to $130 per dose once the US government pulls out of the vaccine program.
If you are uninsured
“If you don’t have insurance, you could end up with the full cost,” says Cynthia Cox, an Affordable Care Act expert at the Kaiser Family Foundation.
But the US still has a significant supply of free vaccines left. The Biden administration ordered 171 million Omicron boosters last year. About 51 million boosters have been administered to date, according to the Centers for Disease Control and Prevention.
The uninsured will continue to have free access to these 120 million doses, but it’s unclear how long the supply will last.
“With the stockpile we have of vaccines and antivirals, we don’t think we will be in a state of hasty transition to drop this on market partners,” the HHS official said.
While vaccine makers are preparing to sell injections to the private market later this year, it’s possible that the federal supply of free injections could last longer because booster uptake is low, Cox said.
“Anyone in the U.S., regardless of citizenship or insurance status, can get a free vaccine while this federal supply lasts,” Cox said.
Sen. Bernie Sanders, I-Vt., denounced vaccine price hikes in a letter to Moderna’s CEO last month. Sanders, chairman of the Senate health committee, said the price increase would cost taxpayers billions because of the impact on Medicaid and Medicare budgets.
“Perhaps most importantly, the quadrupling of prices will make the vaccine unavailable to millions of uninsured and underinsured Americans who cannot afford it,” Sanders said. “How many of these Americans will die from Covid-19 due to limited access to these life-saving vaccines?”
Jha said this week that the Biden administration is committed to helping the uninsured access to Covid injections and treatments.
“We are creating a whole separate set of efforts for the uninsured because, of course, the uninsured cannot necessarily get free vaccines and treatments under the mainstream insurance system,” Jha said Thursday. “We’re working on a plan there.”
The HHS official said one tool the federal government plans to use is a program called Section 317 that provides funding to purchase and administer free injections to uninsured adults.
But for the vast majority of people with private insurance, the Affordable Care Act will cover the cost of the vaccines. Under the ACA, private health insurance is required to cover all CDC-recommended immunizations at no cost to the consumer.
Medicare would cover vaccinations for seniors, who are most vulnerable to the virus, and lower-income people could get the vaccine through Medicaid.
There may be a small number of old pre-ACA private health insurance policies that are not required to cover Covid vaccines, Cox said. The HHS official said most of those plans will likely pay for the shots.
In addition, some short-term insurance policies may not pay for the vaccines, Cox said. These plans were expanded 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 have gotten used to getting vaccinated at any pharmacy during the pandemic may need to go to a specific drugstore to get a free shot in the future, she said.
Consumers could also see their health insurance premiums rise if Pfizer and Moderna raise the price of the injections, Cox said.
Paxlovid may not be free
Some patients, depending on their insurance policy, may also have to pay for Pfizer’s Paxlovid antiviral pill in the future. Unlike preventative services such as vaccines, the ACA does not require insurance to cover treatments.
Bourla told market analysts this week that Pfizer expects to start selling Paxlovid at commercial prices through the retail market in the second half of 2023.
Pfizer has not announced how much the antiviral will cost once it goes commercial. 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 of the price will be covered by insurance.
Dawn O’Connell, chief of the federal agency responsible for US supplies, said last August that the Department of Health and Human Services expected Paxlovid to run out by mid-2023.
Jha said on Tuesday there are still millions of doses of Paxlovid and omicron boosters in the US stockpile. “They will continue to be available for free to all Americans who need them,” Jha said of the remaining federal supply.