A health care worker prepares a dose of the Pfizer-BioNTech Covid-19 vaccine at the vaccination clinic in the library of the Peabody Institute in Peabody, Mass., Wednesday, Jan. 26, 2022.
Vanessa Leroy | Bloomberg | Getty Images
For now, uninsured Americans can still get a free Covid-19 vaccine, even though the public health emergency in the U.S. is over.
this Biden administration The three-year-old state of emergency declaration that allowed the government to provide enhanced social safety net benefits and free Covid vaccines, tests and treatments during the pandemic was lifted on Thursday.
but availability and cost How many of those vaccines are actually determined by the free supply of vaccines provided by the federal government, not by the public health emergency.
This means that no one, whether insured or uninsured, will have to pay out of pocket for a Covid vaccine as long as the stockpile remains available.
Providers of the federally purchased Covid vaccine cannot bill patients based on a person’s insurance status, or deny them a shot, According to CDC.
The Biden administration ordered 171 million omicron Covid boosters last July.Since then, about 56 million The CDC said omicron injections have been administered.
This provided more than 100 million free injections to the public. The government estimates that supplies could continue into the fall.
“There are many, many doses left. As you know, booster uptake isn’t great,” said Jen Kates, senior vice president. Kennedy Foundationa health policy research institute.
But even after the federal government’s stockpile runs out, the vast majority of Americans won’t have to pay for a Covid vaccine out of pocket.
Once the supply is gone, the government will shift the distribution of the Covid vaccine to the private market.
This means that vaccine manufacturers Pfizer and modern will sell their vaccine directly to healthcare providers for around $130 a dose — nearly five times the current price.
Insured Americans will be able to get a Covid vaccine as part of their coverage without paying out of pocket.
Private insurance companies and government-run Medicare and Medicaid programs must cover all CDC-recommended vaccinations.
But for uninsured Americans, federal and corporate programs aim to fill the void.
There are still open questions about what those efforts will look like.
Here’s what we know about these programs so far:
Childhood Vaccine Program
CDC’s The Children’s Vaccine Program will provide free Covid vaccines to children whose families or caregivers cannot afford them once the vaccine hits the commercial market.
Children and youth 19 years of age or younger who are uninsured, underinsured, or eligible for Medicaid are eligible for Permanent VFC program.
The scheme already provides free injections for other diseases, Such as measles and chickenpox.
The CDC’s decision to include the Covid vaccine in the free vaccine program is critical to keeping many children vaccinated — especially those who are no longer eligible 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 if there is no public health emergency. a report Last year from the Department of Health and Human Services.
HHS Bridge Access Program
The Biden administration has proposed creating a permanent program similar to the VFC for uninsured adults who cannot afford the Covid vaccine and vaccines for other diseases. But so far, Congress has not enacted the proposal into law.
Meanwhile, the government last month launched a “HHS Bridge Access Program,” An interim measure that would provide free Covid shots and treatments to uninsured Americans once the products hit the commercial market.
Under the arrangement, the CDC will continue to purchase Covid vaccines at discounted prices and distribute them through 64 state and local health departments.
The HHS effort will leverage drugmakers’ “public commitments” to provide free Covid vaccines and treatments to the uninsured. As part of these commitments, HHS wants manufacturers to provide injectables directly to pharmacies at no cost.
Cates says HHS appears to be referring to Pfizer and Moderna Newly Announced Patient Assistance Programworking to provide free Covid vaccines and treatments to the uninsured.
“From what I understand, HHS is basically saying that it will pay pharmacies to provide vaccines and treatments to the public, and that manufacturers will provide free vaccines and treatments directly to pharmacies as part of their patient assistance program,” Cates said. told CNBC.
Pfizer and Moderna have not said whether they will offer free vaccines to pharmacies.
Cates said the Bridge Access Program overall “will definitely help” some uninsured Americans, but added that it was still “difficult to gauge” how many people would benefit from it and how long the program would last.
Pfizer and Moderna’s project
Both Pfizer and Moderna intend to launch patient assistance programs for their Covid vaccines, but the companies have provided few details about those efforts.
Claire Hannan, executive director of the Association of Immunization Managers, said patient assistant programs typically involve pharmacies and other vaccine providers paying companies up front for the drugs.
These providers can submit reimbursement claims to the program to reimburse the cost of the drug after it has been administered to eligible patients, she said.
Pfizer’s patient assistance program will allow eligible uninsured Americans to receive its Covid vaccine for free after the vaccine moves to the commercial market, according to a company spokesman.Pfizer already has aid program instead of other medicines.
The company will share more information on the assistance program application process and eligibility guidelines when available, the spokesperson added.
Moderna said in February that its Patient Assistance Program It will take effect after the public health emergency is over.
The company did not immediately respond to CNBC’s questions for more details on the plan.
Legislators and health policy experts have harsh criticism Difficult to access and understand patient assistance programs.
A 2018 Study Advising providers don’t always know which patients are best candidates for these programs because of a lack of clear information about eligibility and benefits.
Companies will have to make sure the uninsured can easily get free Covid vaccines through their patient assistance programs, Hannan said.
“If you make it challenging and have them jump through multiple hoops, the uptake of the vaccine may not be as high as we would like to see it,” Hannan told CNBC.