A healthcare worker prepares a dose of the Pfizer-BioNTech Covid-19 vaccine at a vaccination clinic at the Peabody Institute Library in Peabody, Massachusetts, on Wednesday, January 26, 2022.
Vanessa Leroy | Bloomberg | Getty Images
Uninsured Americans still have free access to Covid-19 vaccines for now, even though the US public health emergency is over.
The Biden administration on Thursday lifted the three-year-old emergency declaration, allowing the government to provide enhanced social safety net benefits and free Covid vaccines, tests and treatments during the pandemic.
But the availability and cost of those vaccines is actually determined by the provision of free injections by the federal government, not the public health emergency.
That means people with or without insurance won’t have to pay out of pocket for Covid shots, while supplies last.
Providers of federally sourced Covid vaccines cannot charge patients or deny injections based on a person’s insurance status, according to the Centers for Disease Control Prevention.
The Biden administration ordered 171 million Omicron Covid boosters last July. Since then approx 56 million omicron shots have been administered, the CDC says.
That leaves over 100 million free shots available to the public. The government estimates that the supply could last until the autumn.
“There are still a lot of doses left. As you know, the booster’s absorption wasn’t very good,” said Jen Kates, senior vice president of KFFa health policy research organization.
But the vast majority of Americans won’t have to pay out of pocket for Covid vaccines, even after the federal government’s supplies run out.
The government will move distribution of the Covid vaccine to the private market once that supply runs out.
That means vaccine makers Pfizer And Moderna will sell their injections directly to healthcare providers for about $130 per dose — an almost fivefold increase over current prices.
Insured Americans can access Covid shots as part of their coverage, without having to pay out of pocket.
Private insurers and the government-run Medicare and Medicaid programs are required to cover all injections recommended by the CDC.
But for uninsured Americans, federal and corporate programs are trying to fill the gap.
There are still open questions about what those efforts will look like.
Here’s what we know about those programs so far:
Children and teens 19 or younger who are uninsured, underinsured, or eligible for Medicaid are eligible for the permanent VFC program.
That program already gives free injections for other diseases, such as measles and chickenpox.
The CDC’s decision to include Covid vaccinations in the free vaccine program will be critical to maintaining access for many children — especially those who no longer qualify for other programs.
As many as 5 million children are expected to lose their health insurance through Medicaid or the Children’s Health Insurance Program without a public health emergency, according to a report last year from the Department of Health and Human Services.
The Biden administration proposed creating a permanent program, similar to VFC, for uninsured adults who cannot afford Covid vaccines and injections for other diseases. But Congress has not yet passed that bill into law.
Meanwhile, last month, the administration launched the “HHS Bridge Access Program,” a temporary effort that will provide free Covid injections and treatments to uninsured Americans once those products hit the commercial market.
Under the arrangement, the CDC will continue to purchase and distribute discounted Covid vaccines through 64 state and local health departments.
That HHS effort will leverage drug makers’ “public commitments” to provide free Covid vaccines and treatments to the uninsured. HHS expects manufacturers to provide free injections directly to pharmacies as part of those commitments.
Kates said that HHS seems to refer to those of Pfizer and Moderna newly announced patient assistance programscommitted to providing free Covid vaccines and treatments to the uninsured.
“From what I understand, HHS is basically saying it will pay pharmacies for the cost of administering vaccines and treatments to the public, while manufacturers will directly provide pharmacies with free vaccines and treatments as part of their patient assistance programs,” he said. Kates to CNBC.
Pfizer and Moderna have not said whether they would provide free injections to pharmacies.
Kates said that overall the Bridge Access program will “certainly help some uninsured Americans,” but added that it’s still “difficult to estimate” how many people will benefit from it and how long the program will be in place. to stay.
Pfizer and Moderna both plan to launch patient assistance programs for their Covid injections, but the companies have provided few details about those efforts.
Typically, pharmacies and other vaccine providers are involved in patient assistance programs that pay a company upfront for a drug, according to Claire Hannan, executive director of the Association of Immunization Managers.
She said those providers can then submit a refund request to the program for the cost of that drug after administering it to an eligible patient.
Pfizer’s patient assistance program will allow eligible uninsured Americans to access its Covid shot for free once the vaccines are shifted to the commercial market, a company spokesman said. Pfizer already has that an assistance program in place for his other drugs.
The company will share further information about the tool’s application process and eligibility guidelines when it becomes available, the spokesperson added.
Moderna in February said so patient support program would come into force after the public health emergency has ended.
The company did not immediately respond to CNBC’s questions about additional details about the program.
Legislators and health policy experts have heavily criticized patient assistance programs because they are difficult to access and understand.
A 2018 study proposed providers do not always know which patients would be best for those programs due to a lack of clear information about eligibility and benefits.
Hannan said companies will need to ensure that people without insurance have easy access to a free Covid shot through their patient assistance programs.
“If you make it challenging and have them jump through multiple hoops, the vaccine uptake probably isn’t going to be where we’d like to see it,” Hannan told CNBC.