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WASHINGTON — The price of the COVID-19 medication Paxlovid is likely to rise next year for most patients as the United States continues to transition out of the emergency phase of the pandemic, sparking concerns among doctors that it will become less accessible.
Just as with COVID-19 vaccines this season, the antiviral — a combination of the drugs nirmatrelvir and ritonavir — will move from being available free to everyone through government purchases to a more traditional commercial marketplace for most patients at the end of this year, according to the U.S. Department of Health and Human Services and drugmaker Pfizer.
The new price — the cost before insurance — hasn't been set but is expected to be higher than the $530-per-course price paid by the U.S. government.
People who are on Medicare or Medicaid or who are uninsured will still be able to get Paxlovid for free through 2024 via a patient assistance program, according to the Department of Health and Human Services, but those with commercial insurance are likely to face a copay, Pfizer chief executive Albert Bourla said Monday. About 40% of prescriptions of Paxlovid are written for Medicare and Medicaid patients, he said.
"We are starting negotiations with payers," Bourla told analysts and investors on a company conference call. The "pandemic price" paid by the U.S., he said, is likely to be "lesser" than the new commercial price.
One financial analyst who follows the company, Evercore ISI's Umer Raffat, suggested that the price could go up three- to fivefold, to as much as $2,500 per course.
Dr. Eric Topol, a professor of molecular medicine at Scripps Research, called the potential plans for a price increase "more bad news of price gouging by Pfizer."
"Less people who need Paxlovid will get it — whether it's because of lack of insurance, or concerns about payment/co-pay," Topol wrote in an email. "Even for those who have full coverage, sticking it to insurers just winds up, in the long run, increasing health care insurance premiums for all."
Infectious disease physicians shared Topol's concern about people's ability to get the medication.
"There's no doubt that cost is a major factor in determining access to medication in the United States," said Dr. Paul Sax, clinical director of the Infectious Disease Clinic at Brigham and Women's Hospital and a professor of medicine at Harvard Medical School. He noted that insurance plans vary widely in coverage and how much people have to pay out of pocket.
"The higher these costs are," he said, "the more likely people are to forego treatment."
A Pfizer spokesman said that the company plans to share information about pricing "in the coming weeks" and that "Paxlovid has and will continue to provide value to eligible patients, providers and health care systems due to its important role in helping reduce COVID-19-related hospitalizations and deaths among people who are at high risk for progression to severe illness."
