The US is planning to stop buying Covid shots in the fall. it means

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A pharmacist dispenses a COVID-19 booster dose at a Chicago CVS store in October.

Antonio Perez | Tribune News Service | Getty Images

The US will stop buying Covid shots at low cost for the entire country and shift vaccine distribution to the private market as soon as possible, shifting the cost onto US insurers and uninsured Americans who will lose access to free vaccines.

White House COVID response coordinator Dr. Ashish Jha said in an interview with the UCSF Department of Medicine on Thursday that a transition to a private market would happen in the summer or early fall, though no exact date has been set.

A senior Department of Health and Human Services official told CNBC that the fall would be a natural time to transition to a private market, especially if the Food and Drug Administration selects a new COVID strain for vaccines and manufacturers further update shots. asks to produce. In respiratory virus season.

America has bought vaccines directly for the last two years pfizer And Moderna According to the Kaiser Family Foundation, at an average cost of about $21 per dose.

The federal government requires pharmacies, doctor’s offices and hospitals to provide these shots free of charge to everyone regardless of their insurance status.

if you have health insurance

When the federal COVID vaccination program ends, vaccines will remain free for people who have health insurance because of requirements under the Affordable Care Act.

But when can uninsured adults pay for their vaccinations? pfizer And Moderna Start selling the shots on the private market and the existing federal stockpiles run out. There is a federal program to provide free vaccines to children whose families or caregivers cannot afford the vaccine.

Jha said on Tuesday that the planned switch is not tied to the end of the Covid public health emergency in May.

“The end of PHE doesn’t mean people will suddenly not be able to get the vaccines and treatments they need,” Jha wrote in a Twitter thread on Tuesday.

When the federal government no longer buys vaccines at a discount for the entire country, individual health care providers will buy vaccines from vaccine manufacturers at a higher price.

Moderna CEO Stéphane Bancel told CNBC last month that the company is preparing to market the vaccine to the private market as soon as this fall. Pfizer CEO Albert Bourla told investors during the company’s earnings call this week that he is preparing to commercialize the vaccine in the second half of the year.

Pfizer and Moderna have said they are considering raising the price of the vaccines to around $110 to $130 per dose after the US government pulls out of the vaccine program.

if you are not insured

“If you’re uninsured, you may end up facing the full cost,” said Cynthia Cox, Affordable Care Act specialist at the Kaiser Family Foundation.

But America still has enough stock of free vaccines left. The Biden administration ordered 171 million Omicron boosters last year. About 51 million boosters have been given so far, according to the Centers for Disease Control and Prevention.

Those without insurance will continue to have free access to these 120 million doses, but it is unclear how long the supply will last.

“With the supply of vaccines and antivirals we have, we don’t think we’re going to be in the position of initial infection to drop it on market participants,” the HHS official said.

Although vaccine makers are preparing to sell the shots on the private market later this year, Cox said, it is possible that the federal stockpile of free shots could last longer because booster uptake has been low.

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“Everyone in America is able to get a free vaccine as long as this federal stockpile lasts, regardless of their citizenship status or their insurance status,” Cox said.

Sen. Bernie Sanders, I-Vt., denounced vaccine price hikes in a letter to Moderna’s CEO last month. Sanders, who chairs the Senate Health Committee, said the price hike would cost taxpayers billions through its impact on the budgets of Medicaid and Medicare.

“Perhaps most importantly, quadrupling the price would make the vaccine unavailable to the millions of uninsured and underinsured Americans who would not be able to afford it,” Sanders said. “How many of these Americans will die from COVID-19 as a result of limited access to these life-saving vaccines?”

Jha said this week that the Biden administration is committed to helping uninsured people access Covid shots and treatments.

“We’re making a completely different effort for the uninsured, because of course, free vaccines and treatment by definition won’t be free under the regular insurance system,” Jha said on Thursday. “We’re working on a plan on that.”

The HHS official said one tool the federal government plans to use is a program called Section 317 that provides money to purchase and administer shots to uninsured adults at no cost.

aca requirements

But for most people with private insurance, the Affordable Care Act will cover the cost of the vaccines. Under the ACA, private health insurance is required to cover all CDC-recommended vaccinations at no cost to the consumer.

Medicare will cover the shots for seniors, who are most vulnerable to the virus, and low-income people can get the vaccine through Medicaid.

Cox said there may be some legacy private health insurance plans from before the ACA that are not required to cover COVID vaccines. The HHS official said most of these plans will pay for the shots.

In addition, some short-term insurance policies may not pay for vaccines, Cox said. These plans were expanded during the Trump administration and are not required to comply with the ACA.

Cox said the ACA also allows private insurance to limit vaccine coverage to in-network providers. He said that people who have become accustomed to getting vaccinated at any pharmacy during the pandemic may have to go to a specialized drug store to get free shots in future.

Cox said consumers could see an increase in their health insurance premiums if Pfizer and Moderna raise the price of the shots.

paxlovid may not be free

Some patients, depending on their insurance policy, may also have to pay for Pfizer’s antiviral pill Paxlovid in the future. Unlike preventive services such as vaccines, the ACA does not require insurance to cover the treatment.

Bourla told market analysts this week that Pfizer expects to begin selling paxlovid at commercial prices through the private market in the second half of 2023.

Pfizer has not announced how much the antiviral will cost once it goes commercial. The federal government is paying about $530 for a five-day treatment course. It’s not clear how much patients will have to pay out of pocket and how much of the cost insurance will cover.

Don O’Connell, who heads the federal office responsible for the US stockpile, said last August that the Department of Health and Human Services expected to run out of paxlovid by mid-2023.

Jha said Tuesday that there are millions of doses of Paxlovid and Omicron boosters still in US stockpiles. Jha said of the remaining federal supplies, “They will continue to be available for free to all Americans who need them.”

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