The era of “free” COVID vaccines, test kits and treatments is coming to an end. Who pays the bill now? – Orange County Registry

The time is running out for free COVID vaccines, at-home testing kits, and even some treatments.

The White House announced this month that the national health emergency, first declared in early 2020 in response to the pandemic, will expire on May 11. When it ends, many of the measures taken to combat the spread of the virus will also end.

take vaccinations. So far, the federal government has been buying COVID-19 vaccines. Recently, the company bought 105 million doses of Pfizer-BioNTech’s bivalent booster at about $30.48 per dose and 66 million doses of Moderna’s version at $26.36 per dose. (These are among the companies that developed the first Covid vaccines sold in the United States.)

People will be able to get these vaccines at little or no cost while government-bought supplies last. But even before the end date for the public emergency was set, Congress chose not to allocate any more money to top up the government’s dwindling supplies. As a result, Pfizer and Moderna were already planning their move into the commercial market. Both have indicated they will raise prices in the range of $110 to $130 per dose, although insurers and federal health programs could negotiate lower rates.

“We see a two-digit billion amount[-dollar] Market opportunity,” Ryan Richardson, BioNTech’s chief strategy officer, told investors at a recent JPMorgan conference in San Francisco. The company expects a gross price — full price before discounts — of $110 per dose, which Richardson says is “more than justified from a health economic perspective.”

That could bring tens of billions of dollars in revenue for manufacturers, even if uptake of the vaccines is slow. And consumers would foot the bill, directly or indirectly.

If half of adults — roughly the same percentage as those who choose to get an annual flu shot — received COVID boosters at the new, higher prices, it would cost insurers, employers and other payers $12.4 billion to $14.8 billion shell out, according to a recently published KFF report. That’s almost double what it would have cost any adult in the US to get a bivalent booster pack at the average price paid by the federal government.

Regarding Covid treatments, a blog post by the Department of Health and Human Services’ Strategic Preparedness and Response Administration in August noted that government-purchased stocks of the drug Paxlovid are expected to last until mid-year before the private sector takes over. The government’s bulk purchase price from manufacturer Pfizer was $530 for one treatment, and it’s not yet known what the companies will charge when government supplies run out.

How much of this pinch will consumers feel?

One thing is certain: how much of the increased cost, if any, is passed on to consumers depends on their health insurance plan.

Medicare beneficiaries, those enrolled in Medicaid — the state health insurance program for people on low incomes — and those with Affordable Care Act coverage will continue to receive COVID vaccines at no cost even after the public health emergency ends and the government they buy vaccines are going out. Many people with work-related insurance are also unlikely to have to pay co-payments for vaccines unless they go off-network for their vaccinations. Individuals with limited benefits or short-term insurance may have to pay for all or part of their vaccinations. And people who don’t have insurance must either pay the full cost out of pocket or request free or low-cost vaccinations from community clinics or other providers. If they can’t find a free or inexpensive option, some uninsured patients may be forced to skip vaccinations or tests.

It becomes especially difficult to raise $100 or more for the vaccine “if you are uninsured or underinsured; This is where these price increases could create additional inequalities,” said Sean Robbins, executive vice president of external affairs for the Blue Cross Blue Shield Association. Those increases, he said, will also affect policyholders as the cost “flows into premiums.”

Meanwhile, public policy experts say many private insurers will continue to cover Paxlovid, although patients may face a co-payment, at least until they meet their deductible, just like with other drugs. Medicaid will continue to pay for patients at no cost until at least 2024. However, Medicare coverage is limited until the treatment goes through the regular FDA process, which takes longer than the emergency use authorization under which it was marketed.

Another complication: Uninsured lists are likely to rise over the next year as states prepare to resume the process of regularly determining Medicaid eligibility, which was halted during the pandemic. Beginning in April, states will begin reevaluating whether Medicaid registrants meet income and other qualifying factors.

An estimated 5 to 14 million people across the country could lose insurance coverage.

“This is our number one concern right now,” said John Baackes, CEO of LA Care, the nation’s largest publicly operated health plan with 2.7 million members.

“They may not realize they’ve lost insurance coverage until they fill out a prescription” or seek other medical care, including immunizations, he said.

What about COVID test kits?

For insurers, including Medicare and Affordable Care Act plans, rules remain in effect to cover the cost of up to eight home testing kits per month for each person on the plan until the public health emergency ends.

For consumers – including those without insurance – a government website is continuing to offer up to four test kits per household until they run out. The Biden administration shifted funding to purchasing additional kits and made them available in late December.

Beginning in May, however, original Medicare beneficiaries and many individuals with private, occupational insurance will have to pay for the rapid antigen test kits out of pocket. Some Medicare Advantage plans that are an alternative to the original Medicare may choose to continue covering them at no co-payment. Policies vary, so check with your insurer. And Medicaid registrants can get the test kits free for just over a year.

State regulations may also vary, and continued non-shared coverage for COVID testing, treatment, and vaccines after the health emergency ends may be available with some health plans.

Overall, the future of COVID testing, vaccines and treatments will reflect the complicated mix of coverages consumers already use for most other types of care.

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

KHN correspondent Darius Tahir contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the nation. The era of “free” COVID vaccines, test kits and treatments is coming to an end. Who pays the bill now? – Orange County Registry

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