Does Insurance Cover Paxlovid and Other Covid-19 Treatments

Insurance coverage for Paxlovid and other COVID-19 treatments varies depending on the type of insurance plan you have. Some plans may cover the full cost of treatment, while others may require you to pay a portion of the bill.

Many employer-sponsored health plans, including those offered through the Affordable Care Act, typically cover prescription medications, including Paxlovid, with no out-of-pocket costs to the patient.

Some insurance plans may require a prior authorization or step therapy requirement before covering COVID-19 treatments, including Paxlovid. This means you may need to try other treatments first before being approved for Paxlovid.

Explore further: Can Insurance Cover Plan B

COVID-19 treatment options are available outside of the hospital for people who are more likely to get very sick. These options are approved or authorized by the FDA and the CDC.

The Infectious Diseases Society of America and the CDC provide guidelines on treating and managing patients with COVID-19. You can find more information on these guidelines on the CDC website.

There are several medicines that are commonly used to treat mild to moderate COVID-19. These medicines include Nirmatrelvir plus ritonavir (Paxlovid), Remdesivir (Veklury), and Molnupiravir (Lagevrio).

Here are the details of these medicines:

Paxlovid is often the recommended choice for many people, but it might interfere with other medications you may be taking. Remdesivir is the second preferred treatment option after Paxlovid. Molnupiravir might be recommended for people who are unable to take either Paxlovid or Remdesivir.

Paxlovid is free for those on Medicare, Medicaid, or other government-sponsored coverage through a government patient assistance program called Paxcess, which is operated by Pfizer.

You must enroll in the Paxcess program prior to filling a prescription to benefit from this program.

For those with commercial insurance, Pfizer offers a copay assistance program, but you'll need to have a prescription for Paxlovid and then enter your personal information on the website Paxlovid.iassist.com.

The actual prices and copay amounts for Paxlovid can vary depending on your coverage, and it's a good idea to check your insurance plan's formulary to see if Paxlovid is covered.

For example, one person with large group coverage found that their plan would pay $1,191.25 for a Paxlovid prescription, and they would pay a $135 copayment for a five-day supply.

Be aware that there is a long list of drugs that are contraindicated if you're taking Paxlovid, which you can find on the Pfizer-sponsored website.

If you're uninsured or have Medicare, you can get Paxlovid for free by going to paxlovid.com/paxcess or calling 877-219-7225.

If you're uninsured or on Medicare, Medicaid, or other government-sponsored coverage, you may qualify for a patient assistance program to get Paxlovid for free. This includes Pfizer's Paxcess program, which can be accessed by visiting paxlovid.com/paxcess or calling 877-219-7225.

Paxlovid is not covered by Medicare Part D plans this year, but it's provided at no charge through the Paxcess program. You must enroll in this program prior to filling a prescription to benefit from it.

For those with commercial insurance, Pfizer has a co-pay assistance program available through Paxlovid.iassist.com. However, you'll need to have a prescription for Paxlovid and enter your personal information to access the program.

If you have difficulty using the website, you can call the Pfizer Information Center at 877 219-7225 for assistance.

Here's a breakdown of the costs associated with Paxlovid:

As you can see, the cost of Paxlovid varies widely depending on your coverage and circumstances. If you're uninsured or on Medicare, Medicaid, or other government-sponsored coverage, you may qualify for a patient assistance program to get Paxlovid for free.

It's worth noting that there are other options available, such as registering for TestToTreat.org or checking with your insurer to see if they offer any assistance programs. You can also check with city or state programs, or hospital programs, to see if they offer any help.

Paxlovid is an antiviral medication used to treat COVID-19.

Insurance coverage for Paxlovid varies depending on the type of insurance plan you have.

Some insurance plans may cover Paxlovid as part of their prescription medication coverage.

The cost of Paxlovid without insurance can be prohibitively expensive, with prices ranging from $500 to $2,000 per treatment course.

Paxlovid is a prescription medication, so you'll need to talk to your doctor or healthcare provider to get it.