In the battle to prevent severe cases of COVID, the oral medication Paxlovid has become a standard treatment, with nearly 6 million courses of therapy given in the U.S.  Until now, this drug has been free to patients as the government has sprung for the cost. In a few months, however, that won’t be the case, leaving those who are at most risk for major illness (the elderly and uninsured) having to pay a substantial price, currently more than five hundred dollars.

Although the COVID pandemic seems to have abated in the United States, the number of daily worldwide cases as of Nov. 22, 2022 are about the same as the same date two years earlier. With winter coming in the U.S., some are concerned about a possible resurgence of the virus. Death rates from COVID remain at about one percent, more in the senior population. Indeed, the health department of Billings, MT logged six deaths due to the virus. Two of the deceased were in their 90s, two in their 80s, and one each in their 60s and 70s.

Many billions of dollars have been spent on (sometimes hastily) developed options to treat or, at least, mitigate, the effects of COVID. Paxlovid, a combination of two drugs, is credited with a decrease in hospitalizations and deaths from the virus. The Department of Health and Human Services, however, will soon stop supplying free treatments, forcing pharmacies to buy and bill for them on the market just as they do other meds. (this will, by the way, also affect COVID vaccines, which will go from $30 to about $120).

Close to 90 percent of those dying from COVID are 65 or older, the age where Medicare covers many medical costs. Unfortunately, Medicare Part D would be restricted from covering the cost of Paxlovid. It’s only available now due to an FDA emergency use authorization. Until FDA gives full approval to the drug, it won’t be covered for the people most at risk.

A government approval for an additional 2.5 billion dollars is in the works, but there’s no guarantee funds will be available to continue the free program. Many citizens are already facing difficulties get Paxlovid prescriptions, but there’s a procedure by which a COVID-positive patient might obtain it directly from the pharmacy (with proof of recent normal liver and kidney studies).

Even if you have health insurance, paying for COVID therapy is not a guaranteed thing. Eventually, I expect they will figure out the medicine is less expensive that a hospital stay, but it may take months. At the very least, expect higher copays. One bit of good news is that those on public insurance plans for low-income populations, like Medicaid, will have Paxlovid covered until at least 2024. Also, the government has only used a third of the 20 million doses it purchased from Pfizer Pharmaceuticals. It’s hoped that these surplus doses will be made available, if not for free, then for a sizable discount.

Clearly, when faced with a potentially large medical bill, many patients will forego getting the medicine, which could lead to bad outcomes. The government, and even private insurers, would be remiss in not making sure that Paxlovid and other COVID treatments are affordable. Perhaps, they should review the data on the effectiveness of more affordable treatments not currently FDA-approved but suggested by the Front Line COVID Critical Care Alliance. Face it: Any oral medication is far less expensive than two weeks in the intensive care unit. Lives will be saved by keeping COVID treatments affordable for the American citizen.

Joe Alton MD

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