COVID-19 Treatment Goes to Commercial Market

October 31, 2023

The Biden administration is aiming for a smooth transition as the rollout of COVID-19 treatments shifts to the private commercial market on Wednesday.

In a letter to drugmakers, distributors, pharmacies, and payors, the U.S. Department of Health and Human Services (HHS) asked for partnership during this transition period as the government moves away from its role as the primary supplier of COVID-19 treatments. The transition follows reports of uneven availability—and issues with insurance codes—that affected access to the updated COVID-19 vaccines following their debut on the commercial market last month

“As the federal government transitions away from distributing these products, access will primarily depend on the arrangements in the private commercial market among each of the particular drug manufacturers and private insurers,” Xavier Becerra, HHS secretary said in the letter. “We urge the drug manufacturers and private insurers to work together to ensure access to these lifesaving medications.”

Here’s what you need to know:

• What’s changing:  Starting tomorrow, two manufacturers of oral antivirals (Pfizer and Merck) will begin to distribute product through traditional channels.
  • The oral antiviral Lagevrio also will begin to transition as an option for eligible individuals who are unable to take Paxlovid or Veklury.
• Paxlovid access:  Earlier this month, the federal government announced people on Medicare, Medicaid, and those who do not have insurance will have access to Paxlovid with no out-of-pocket costs.
• A clear path:  The federal government is calling for manufacturers to work with CMS and other payors to make sure they have the necessary information to make payments for COVID-19 therapies as the commercial rollout begins.
• Noteworthy:  Providers who have federally acquired products are encouraged to use them until they are depleted or until they expire—at no cost to patients.
• Quotable:  “It is of paramount importance that these medications remain widely accessible to high-risk patients after commercial distribution begins in order to minimize hospitalizations and deaths from COVID-19,” Becerra said.

COVID-19 hospitalizations (16,186) remained level for the week ending October 21, while emergency department visits declined 4.6 percent in that time. HAP continues to monitor the latest COVID-19 public health developments and provide updates to members and the general public.

Becerra’s letter to the medical community is available online.