Era of ‘free’ COVID vaccines, test kits and treatments is ending

The White House announced this month that the national public health emergency, first declared in early 2020 in response to the pandemic, will expire May 11. When it ends, so will many of the policies designed to combat the virus’s spread.

Take vaccines. Until now, the federal government purchased COVID-19 shots. It recently bought 105 million doses of the Pfizer-BioNTech bivalent booster for about $30.48 a dose, and 66 million doses of Moderna’s version for $26.36 a dose.

People will be able to get these vaccines at low or no cost as long as the government-purchased supplies last. But even before the end date for the public emergency was set, Congress opted not to provide more money to increase the government’s dwindling stockpile.

As a result, Pfizer and Moderna indicated they will raise prices, somewhere in the range of $110 to $130 per dose, though insurers and government health programs could negotiate lower rates.

“We see a double-digit billion(-dollar) market opportunity,” Ryan Richardson, chief strategy officer for BioNTech, told investors recently at a JPMorgan conference in San Francisco. The company expects a gross price — the full price before any discounts — of $110 a dose, which, Richardson said, “is more than justified from a health economics perspective.”

That could translate to tens of billions of dollars in revenue for the manufacturers, even if uptake of the vaccines is slow. Consumers would foot the bill, either directly or indirectly.

If half of adults — about the same percentage as those who opt for an annual flu shot — get COVID-19 boosters at the new, higher prices, a recent KFF report estimated, insurers, employers and other payers would shell out $12.4 billion to $14.8 billion. That’s up to nearly twice as much as what it would have cost for every adult in the U.S. to get a bivalent booster at the average price paid by the federal government.

As for COVID-19 treatments, an August blog post by the Department of Health and Human Services’ Administration for Strategic Preparedness and Response noted that government-purchased supplies of the drug Paxlovid are expected to last through midyear before the private sector takes over.

The government’s bulk purchase price from manufacturer Pfizer was $530 for a course of treatment, and it isn’t yet known what the companies will charge once government supplies run out.

How much, if any, of the boosted costs are passed on to consumers will depend on their health coverage.

Medicare beneficiaries, those enrolled in Medicaid and people with Affordable Care Act coverage will continue to get COVID-19 vaccines without cost sharing, even when the public health emergency ends and the government-purchased vaccines run out.

Many with job-based insurance will also likely not face copayments for vaccines, unless they go out of network for their vaccinations. People with limited-benefit or short-term insurance policies might have to pay for all or part of their vaccinations.

People who don’t have insurance will need to either pay the full cost out-of-pocket or seek no- or low-cost vaccinations from community clinics or other providers. If they cannot find a free or low-cost option, some uninsured patients may be forced to skip vaccinations or testing.

Coming up with what could be $100 or more for vaccination will be especially hard “if you are uninsured or underinsured; that’s where these price hikes could drive additional disparities,” said Sean Robbins, executive vice president of external affairs for the Blue Cross Blue Shield Association.

Those increases, he said, will also affect people with insurance, as the costs “flow through to premiums.”

Meanwhile, public policy experts say many private insurers will continue to cover Paxlovid, though patients may face a copayment, at least until they meet their deductible, just as they do for other medications.

Medicaid will continue to cover it without cost to patients until at least 2024. But Medicare coverage will be limited until the treatment goes through the regular FDA process, which takes longer than the emergency use authorization.

Rules remain in place for insurers, including Medicare and Affordable Care Act plans, to cover the cost of up to eight in-home test kits a month for each person on the plan, until the public health emergency ends.

For consumers — including those without insurance — a government website is still offering up to four test kits per household, until they run out. The Biden administration shifted funding to purchase additional kits and made them available in late December.

Overall, the future of COVID-19 tests, vaccines and treatments will reflect the complicated mix of coverage consumers already navigate for most other types of care.

“From a consumer perspective, vaccines will still be free, but for treatments and test kits, a lot of people will face cost sharing,” said Jen Kates, a senior vice president at KFF. “We’re taking what was universal access and now saying we’re going back to how it is in the regular U.S. health system.”