Why Medicare Won’t Cover Paxlovid

Paxlovid is an experimental oral COVID-19 treatment, and as with other experimental treatments, it’s not covered by Medicare. This is because Medicare does not cover any experimental treatments that have not been proven to be safe and effective.

Therefore, if you are seeking therapy for COVID-19, you may not be able to have Paxlovid covered by Medicare. However, depending on the plan, you may receive some coverage through other insurance plans.

Paxlovid Covid-19 treatment

The development of a novel treatment for COVID-19 known as Paxlovid is promising in the fight against the virus. This treatment is a combination of three novel RNA-based therapies that have been proven to be effective against the virus.

How does Paxlovid work?

Paxlovid is an oral medication designed to boost the immune system to fight the virus. It’s composed of a combination of antiviral, antifungal, and antiviral agents.

Paxlovid targets three distinct targets within the virus, which allows for more effective and targeted inhibition of viral replication. Clinical trials have demonstrated that Paxlovid is well tolerated, with no significant adverse events reported.

Furthermore, patients treated with Paxlovid have reported significant improvements in their symptoms. The therapeutic potential of Paxlovid offers hope to those infected with the virus, and further research is being done to understand the full potential of this treatment.

However, since the medication is still considered to be experimental, Medicare does not yet cover this drug. This is because Medicare requires a certain amount of safety and efficacy data to be collected before a drug can be approved for coverage. As such, the costs associated with Paxlovid are not covered by Medicare.

How is Paxlovid covered currently?

Paxlovid is currently covered by the federal government, but this is expected to end in mid-2023. Paxlovid is expected to be commercialized by then and will be covered by numerous insurance plans.

Medicare coverage for Paxlovid

Will Medicare cover Paxlovid? In general, Medicare covers a wide range of prescription medications as long as they are medically necessary and prescribed by a doctor. However, there are some exceptions.

Paxlovid is a new medication, and it’s not yet approved by the Food and Drug Administration (FDA) and is still considered experimental. Therefore, Medicare does not currently cover it. If the FDA approves Paxlovid, Medicare may begin to cover it.

unfortunately, we expect that when the drug becomes commercialized the price will increase similar to the vaccine. Pfizer plans to charge between $110 and $130 for the Covid vaccine which will be four times the current price. Currently, the negotiated price of Paxlovid is $530 for a single course of treatment.

Alternatives to Paxlovid

There are few alternatives to Paxlovid at this time. The are two others that are considered alternatives, Molnupiravir and Ivermectin. Molnupiravir is another experimental oral medication to treat Covid-19 and Ivermectin is the only FDA-approved medication that’s an alternative oral treatment for Covid-19

Covid-19 FAQs

Why doesn’t Medicare cover Paxlovid?

Paxlovid is still undergoing safety and ethics reviews and is only approved for emergency use. For Medicare to cover a prescription these reviews must be complete and the FDA must approve the medication. Once the approval is given, Medicare will begin to review it, and potentially companies will add it to their plan’s formulary.

When could Medicare potentially begin to cover Paxlovid?

Mid-2023 Paxlovid is expected to be commercialized. If the FDA grants approval then Medicare will review the drug. After review, Medicare may decide to allow plan sponsors to adopt the drug as a Covid-19 treatment.

How are people getting Paxlovid now?

Paxlovid is currently being paid for 100% by the government. That’s expected to continue until the middle of 2023. At that time it’s the expectation that the drug will be commercialized and then private insurance companies may pick up the treatment.

Getting Medicare coverage for Covid-19 treatments

In conclusion, Paxlovid is a new treatment for Covid-19 that uses a combination of antiviral agents to target the virus and reduce its replication ability. While it’s not yet known if Medicare will cover this medication, it’s encouraging that the FDA has granted it emergency use authorization.

This new treatment will help improve prognosis and reduce complications for those living with Covid-19. Fill out our online rate form or call us to review Medicare plans in your area to help offset the costs of Medicare.

 

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