HHS: Patients Should Not Face High Copays for Paxlovid

In a call with pharmacy executives, Department of Health and Human Services (HHS) Secretary Xavier Becerra stressed that “no patient should be charged hundreds of dollars for Paxlovid at the pharmacy counter.” This follows a January 2024 call with pharmacy leaders, pharmacy benefit managers, and insurer.

He reminded attendees at both meetings about the October 2023 agreement with Pfizer, the maker of Paxlovid (nirmatrelvir and ritonavir), to provide access to the COVID-19 treatment. As part of the Pathways program, Pfizer offers commercially insured patients Paxlovid for as little as $0 copay, with annual limit of $1,500. Additionally, Medicare and Medicaid beneficiaries can receive Paxlovid for free through 2024 and people who are uninsured can receive Paxlovid for free through 2028.

The Centers for Medicare and Medicaid Services had issued a guidance in January 2024 indicating that Paxlovid or Lagevrio (molnupiravir), Merck’s oral antiviral drug also used to treat COVID-19, should be made available on Part D formularies. CMS officials said they would review utilization management requirements and will not approve efforts that were overly restrictive or inconsistent with the label. For 2025 and beyond, CMS will incorporate formulary reviews for oral antivirals to treat COVID-19.

HHS’s goal has been for these medications to be available for patients. “It is of paramount importance that these medications remain widely accessible to high-risk patients after commercial distribution begins in order to minimize hospitalizations and deaths from COVID-19,” Becerra said in an October 2023 letter to payers, pharmacies and manufacturers. “The COVID-19 response remains a significant public health priority for the Biden-Harris Administration. People are still at risk of infection and re-infection, and millions are experiencing the longer-term effects of the virus.”

Since last fall, HHS, the Administration for Strategic Preparedness & Response, CMS and Pfizer have regularly met with stakeholder groups to discuss increased Paxlovid access.