Health insurance premiums, especially in the ACA Marketplace, could increase if the federal government ends purchasing of COVID-19 vaccines and boosters.
If the federal government stops covering the costs of COVID-19 vaccinations, the total cost for purchasing booster shots commercially would be between $6.2 billion and $29.7 billion a year, according to new analysis from the Kaiser Family Foundation. (See table below for KFF analysis of three scenarios.) These costs are likely to be covered by both public and private vaccine payers, and could lead to premium increases, finds KFF.
To date, the federal government has spent more than $30 billion on COVID-19 vaccines to ensure that the public can access them at no charge. Pfizer and Moderna have announced that the anticipated commercial price per dose of their vaccines would likely be between $82 and $130 per dose – roughly three to four times what the federal government has paid, according to the KFF analysis.
Analysts with KFF compared the average price paid by the federal government for the COVID-19 bivalent boosters to the estimated average commercial prices that have been suggested by manufacturers. They calculated an overall cost for purchasing vaccines for the adult population across different scenarios of vaccine uptake. They focused on Pfizer and Moderna vaccines, which account for almost all doses administered in the United States (97% as of Nov. 30, 2022).
In total, the federal government has made six different bulk purchases from Pfizer, totaling 655 million doses at $19.50 per dose, and five bulk purchases from Moderna, totaling 566 million doses $15.25 per dose. Other purchases were made at a higher price per dose, with a weighted average across of $20.69.
The price paid per dose increased over time, with the highest prices paid for the bivalent boosters, including 105 million doses at $30.48 per dose from Pfizer and 66 million doses at $26.36 per dose from Moderna. in total, the United States has purchased 171 million doses of the bivalent booster at a cost of $4.9 billion.
KFF analysts expect that most of the costs will be covered by Medicare because older adults are more likely to receive booster shots. Health insurance premiums, especially in the ACA Marketplace, could increase if the federal government ends purchasing of COVID-10 vaccines and boosters. For the uninsured, cost could be a barrier.
Analysts stressed their analysis focused on the cost of a purchasing a single vaccine dose in different scenarios, but it’s possible that doses could be needed more frequently if new variants arrive. Costs will also depend on the number of people who chose to vaccinated.
Source: KFF
Get the latest industry news, event updates, and more from Managed healthcare Executive.
PBM-Offered Genomics Testing Could Reshape Prescribing of Medications
July 25th 2025Two PBMs, True Rx Health Strategies and Capital Rx, are using pharmacogenomics — how a person’s DNA affects their response to medications — to reduce the trial-and-error of prescribing medications, saving employers and patients time and money.
Read More
FDA Extends Review of Blenrep Combinations in Multiple Myeloma
July 24th 2025Last week, an FDA advisory committee against the risk-benefit profile of Blenrep in combination with other therapies. Regulators and reviewers were concerned about the ocular side effects and dosing and tolerability. The new action date is Oct. 23, 2025.
Read More
Sarepta to Pause Shipments of the Gene Therapy Elevidys
July 22nd 2025Sarepta officials said the temporary halt in shipments was done to maintain a productive working relationship with regulators while they address a safety labeling update about the risk of acute liver disease related to Elevidys.
Read More