The Covid antiviral Paxlovid can be free or it can cost $1,600. With the Covid surge continuing, and the price no longer routinely subsidized by the government, what can you do? Here are some options.
First, the manufacturer, Pfizer, is offering a coupon program, called “Paxcess,” which may bring your price to $0 if you are commercially insured. It won’t work for people insured by Medicare, Medicaid or other public insurance. You’ll need to fill out the paperwork to see if you qualify.
Second, Test2treat.org, funded by a National Institutes of Health grant, says it offers both testing and Paxlovid. The free tests (two per person after you sign up) are the molecular amplification tests made by Lucira, which are expensive at retail and relatively accurate — that is, widely believed to be better than the standard at-home rapid tests, yet maybe not as accurate as the PCR tests (which themselves are not perfect, as we have written before). In any case, sign up and get two tests for free, and then if you do get a positive result, the Test2Treat folks are supposed to offer telemedicine which may lead to them sending you Paxlovid (Ritonavir-boosted Nirmatrelvir) if you qualify.
“If you are not currently positive for COVID-19 or Flu (Influenza), you may still enroll if you are an uninsured or underinsured adult (18+), on Medicare, Medicaid, in the VA healthcare system, or receive care from the Indian Health Services,” the Test2Treat site says. “Upon enrollment, when not currently positive, you can receive free tests shipped directly to you and, if you later test positive, you can receive free telehealth care and treatment (if prescribed).”
The program is run by eMed and the University of Massachusetts Chan Medical School. Phone assistance is available at 1-800-682-2829.
My experience: I had multiple tech challenges in signing up at Test2Treat for the tests, but finally made it work after several weeks and many calls and emails to tech support. I haven’t asked for Paxlovid (and hope I don’t have to).
(We wrote about this before here.)
Another twist: Availability is limited
We haven’t done a deep dive, but from anecdotal reports in our circles and reports on social media, it seems that even with aid, Paxlovid can be hard to get.
Supplies seem to be limited in some places — including New York City — but also we have heard many anecdotal reports of patients who have not been able to persuade a doctor to provide a prescription. Reasons vary: “You’re not sick enough,” or “you don’t meet the guidelines,” or “I don’t think it will help you” and so on.
In New York, Betsy Ladyzhets, a founder of The Sick Times, a news organization covering long Covid, wrote on Twitter: “Both my partner and I had to try multiple pharmacies to get Paxlovid, as NYC appears to be in a bit of a shortage, and relied on a neighbor to pick up one of our presriptions. And we live in a city with far more public resources than most of the US!.”
The New York Times wrote recently that the people who might need Paxlovid seem not to be taking it. Only about 15 percent of the people eligible are taking it, The Times wrote.
“It’s not because people don’t know about the drug — most do — but the reluctance seems to come from doctors worried about interactions with other drugs and people wary of a possible rebound case or the metallic aftertaste,” Christina Jewett wrote. “Regional differences offer a clue, with uptake highest in the Democratic strongholds of the Northeast and Pacific Northwest regions of the United States and lowest in deep red areas including Florida and Indiana. Yet no careful study has clarified why so few people used the medication, which cut the risk of death by 73 percent for high-risk patients in the N.I.H. study.”
Dr. Celine Gounder, a New York University epidemiologist, said on Twitter that she is aware that people are having a hard time getting it. She also recommended Paxcess and Test2Treat.
Another person on Twitter wrote: “We recently tried to get Paxlovid for two 80+ year olds (positive on Rapid Tests) 4 hours on phone with a mix of different health care providers and insurance providers Outcome: No Paxlovid unless self-pay So we checked both into ER +Overnight stay then Paxlovid was covered.”
How much does Paxlovid cost?
Without a coupon or Test2Treat, how much does it cost? Well, it could be free, we learned. Or it could be $500 to $1,400. Or it could be $1,600 or $1,500 — or $6.50, or $75.90 for the standard five-day dose. As with so much in the U.S. healthcare market, it depends.
In October, the Department of Health and Human Services said: “As the federal government transitions away from distributing these products, access will primarily depend on the arrangements in the private commercial market among each of the particular drug manufacturers and private insurers,” H.H.S. wrote. “We .. share here our best understanding to date. For Paxlovid, during this transition and through the end of 2024, people who are uninsured and those who have Medicare or Medicaid coverage will continue to access Paxlovid with no out-of-pocket costs through Pfizer’s new patient assistance program.
“Federal entities such as the Indian Health Service, the Department of Veterans Affairs, and the Department of Defense will retain access to Federally-acquired Paxlovid, as they have accessed the product for the last two years. We expect that individuals with private insurance will continue to be able to access Paxlovid as coverage is established over the next few months. Pfizer has also stated that it is setting up a co-pay savings program for those with private insurance, which will be independent of the patient assistance program.”
This is a departure from common practice, in which the patient assistance programs the drug companies set up to reduce patient out-of-pocket costs (and to gain tax breaks) are typically not available to people covered by Medicare, Medicaid or other public insurers.
For another treatment, the lesser-known Lagevrio, there will also be a “transition on November 1, 2023, as an option for eligible individuals who are unable to take Paxlovid or Veklury. Again, we expect there to be commercial coverage for Lagevrio as well, but for those who cannot afford the product, the Merck patient assistance program will be available to assist certain patients,” H.H.S. wrote.
Veklury (Remdesivir) is an IV antiviral. No information about pricing or insurance or co-pay coverage was immediately available.
Price is a barrier
Pfizer’s pricing of Paxlovid has caused a great deal of consternation among public health officials. Price is a barrier, of course. And while it’s not completely clear that Paxlovid helps every patient have an easier course of the disease, or that it helps avert Long Covid, it is widely recommended as one of the only treatments (another is the common and inexpensive generic diabetes medication metformin.)
Some people cannot take Paxlovid — people with kidney and liver disease, for example. Also some medications are counterindicated — so you should check with a doctor.
“Paxlovid is being privatized (i.e., no longer covered by government),” Katelyn Jetelina, who writes as Your Local Epidemiologist on Substack, wrote recently. “Pfizer also announced an astronomical price: $1,400. Cost is a legitimate reason not to get it, which is devastating and ridiculous.”
Merck has not said what the list price for Lagevrio will be, according to the Associated Press. While we could not find any information about that that is recent, a summer GoodRx article said the cost is $700 cash. It seems possible that there are similar considerations on whether it will be covered to the considerations regarding Paxlovid. Lagevrio has been approved only for people 18 and older; Paxlovid is approved for people 12 and up.
This is not medical advice: Not everyone should take Paxlovid or Lagevrio. There are various counter-indications. Various medicines have drug interactions with Paxlovid; find a list on this page for co-pay assistance for Paxlovid drug interactions. Talk to your doctor.
Gaining access to Paxlovid has not always been easy. Some doctors refuse to prescribe for anyone who is not over 65 or at increased risk.
In May 2022 we posted this article about difficulties in getting Paxlovid by Jacqui Neber.
We heard in 2022 of two healthy 20-something New York City women, testing positive at the same time; one got Paxlovid easily and the other could not gain access.
Cities and other cases
Some cities and states may have local programs for Paxlovid. The New York City hotline, for example, should be able to deliver Paxlovid. Call 212-COVID19 (212-268-4319). The program is managed by New York Health + Hospitals, the big public hospital system.
The University of Utah health system has this Covid treatment locator.
Some people are still unable to get it. One woman tweeted: “Grandma Val caught Covid while she was in the hospital. She’s in a rehab facility, in isolation, and getting worse by the day. They couldn’t give her Paxlovid because it wasn’t covered by insurance and it would have cost $1,000 out of pocket. Please send healing thoughts her way. I cannot lose her yet. 2023 has brought enough tragedies as it is.” She wrote that her grandmother is on Medicare.
One woman wrote on Twitter: “Just diagnosed today, here in the US. Doc visit, very thorough, chest Xray, script for Paxlovid. No US health insurance, cost $0. Script dispensed at pharmacy, $6.50.”
Another: “I paid out of pocket Aug 22 for Paxlovid cost me $75.90”
Another: “My paxlovid just cost $1600”
What you can do
There are no one-size-fits-all answers here, but here’s a start.
Consider registering for TestToTreat.org, run by eMed, funded in whole or in part with Federal funds from the National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health and the Department of Health and Human Services. It seems to run after Jan. 1. You need to register first to have access to Paxlovid. Some conditions apply.
The Patient Support Program from Pfizer may offer access. As near as we can tell, it operates like other patient assistance programs — not available for Medicare, Medicaid, Tricare and other government-supported insurance programs. Other conditions may apply.
See if there are city or state programs, or hospital programs like the Utah and New York City ones above.
Check with your insurer.
It seems to be true from what’s above that at least for now, people insured by traditional Medicare and Medicaid are covered at no cost. But if it’s Medicare Advantage, the privatized version of Medicare — we don’t know. The privatized plans are all very different.
Brace yourself for shopping around. You may not feel like racing around to different stores if you’re ill, but one of the people talking about this on Twitter said that HEB grocery store pharmacies were out of stock, but CVS had it free.
A searchable treatment locator map from the Administration for Strategic Preparedness and Response is being re-worked at this site. As we write this, on Jan. 31, 2024, t’s not very useful, but it promises that it is being updated.
