COVID-19 Oral Antivirals have transitioned to the Commercial Marketplace
The federal government has shifted COVID-19 oral antiviral treatments Paxlovid (nirmatrelvir packaged with ritonavir) and Lagevrio (molnupiravir) to the commercial market. For information on upcoming milestones and timelines, please refer to:
Patient Assistance Programs (PAP)
Starting November 2023, patients may encounter co-pays for COVID-19 antivirals. Providers are urged to aid patients in enrolling in a patient assistance program at the point of prescription to acquire medication free of charge or to offset some or all of their out-of-pocket expenses. Enrollment can be completed online or over the phone.
Patient Assistance Programs for COVID-19 Oral Antivirals
- Other state/federal insurance program such as CHIP, Tricare, or VA
Pfizer U.S. Government Patient Assistance Program (USG PAP) Utilizes U.S. Government Purchased Supply
- PAXCESS Patient Support Program
- Tel: 1-877-219-7225 (1-877-C19-PACK)
- Provides Paxlovid at no cost to eligible patients.
- Through December 31, 2024: Individuals uninsured or covered by federal or state programs such as Medicare, Medicaid, CHIP, Tricare or VA Community Care Network benefits can receive Paxlovid at no cost through this program.
- Starting January 1, 2025: Eligible uninsured or underinsured patients can receive Paxlovid at no cost through this program.
- Patients may self-enroll or be enrolled by their caregiver, provider or pharmacist to receive a voucher for use in participating pharmacies.
- Health care providers enrolling patients will be directed to a separate platform to electronically prescribe Paxlovid, with provider and office verification through National Plan and Provider Enumeration System (NPPES) National Provider Identifier (NPI) numbers.
- NPI numbers for providers and organizations for enrollment can be found on the NPPES NPI Registry.
- Providers who prefer to prescribe through their own systems can input patient enrollment information via the Patient/Caregiver pathway to download a USG PAP program voucher for the patient to present at a participating pharmacy.
- Educational materials for patients and providers (brochures, one-pagers, flash cards) are downloadable from Pfizer's Paxlovid Access-Support site.
- Commercial (private) insurance
- PAXCESS Patient Support Program OR
- E Co-Pay Savings Program enrollment which provides co-pay assistance for Paxlovid to eligible patients
- Patients with commercial insurance can self-enroll or be enrolled by their provider or pharmacist to receive a co-pay card, covering up to $1,500 per prescription or the amount of their co-pay, whichever is lower.
- The card must be activated prior to use by calling 1-877-219-7225 (1-877-C19-PACK).
- Patients who have already filled their prescription may enroll in the program afterward and apply for reimbursement.
- Providers can download up to 5 cards for distribution to patients from Pfizer.
- Educational materials for patients and providers (brochures, one-pagers, flash cards) are available for download on Pfizer's Paxlovid Access-Support site.
- Uninsured or whose insurance does not cover Lagevrio.
- Call 800-727-5400 to make an Urgent Need request and follow the representative’s instructions to complete the enrollment form, available at: MerckHelps: LAGEVRIO.
- Provides Lagevrio at no cost to eligible patients.
- Patients without insurance or those whose current coverage does not include Lagevrio may qualify based on household income.
- Providers should call the program number for assistance when making a request. Enrollment forms should be faxed to Merck, and medication will be dispatched to the patient’s address.
- Any address is acceptable, including shelters for individuals experiencing homelessness, physician’s offices, or long-term care facilities.
- Telehealth providers may indicate an X on the form instead of a patient’s signature and include a note documenting that the visit was conducted via telehealth on the cover page.
- Anyone currently in the US, including visitors and unauthorized immigrants, may be eligible.
Other COVID-19 Medications
Additional COVID-19 medications accessible in the commercial market include remdesivir and convalescent plasma. Comparable to other commercially accessible medications, there might be associated costs, including administration expenses like receiving IV infusion in a healthcare facility. Health insurance may cover a portion or all of these expenses.
Patient Assistance Program for Other COVID-19 Antivirals
Outpatient setting only.
- Commercial insurance
Gilead's Advancing Access Program
- Co-pay coupon program for commercially insured patients.
- Patient assistance program for uninsured or underinsured patients.
- Program can provide support with prior authorization and/or appeals process information.
Transition to Commercial Distribution of
Starting November 2023, the distribution of COVID-19 antiviral medications will transition from the federal government to the traditional commercial marketplace. Consequently, some patients with private health insurance may encounter co-pays; however, the majority will still be able to obtain medications at minimal or no expense through patient assistance programs.
For instance, patients covered by Medicare or Medicaid, as well as those without health insurance, can access Paxlovid free of charge via Pfizer’s patient assistance program. Facilities with U.S. government-distributed supply may continue to provide it at no cost to eligible patients during the transition to commercial distribution and the implementation of patient assistance programs.
Federal entities such as the VA (Veterans Affairs), FQHCs (federally qualified health clinics), IHS (Indian Health Service) and DOD (Department of Defense) and others will continue to order US government supply beyond the date of transition to the commercial marketplace until the end of 2024 or until USG supply is exhausted.
Pharmacies and Patient Assistance Programs
Retail pharmacies are urged to engage in the USG PAP program operated by Pfizer to facilitate continued access to Paxlovid for eligible patients at no charge. Retail pharmacies can obtain further information on participating in the USG PAP by contacting the program vendor via email.
Pharmacists are empowered to enroll patients into the patient assistance programs at the time of dispensing to ensure eligible patients can avail of free or low-cost medications. They may also continue prescribing either EUA-labeled Paxlovid or commercially distributed Paxlovid under the existing conditions for pharmacist prescribing (refer to the FDA: Frequently Asked Questions on the Emergency Use Authorization for Paxlovid for details).
Facilities with Excess Inventory
Facilities possessing surplus USG-distributed Paxlovid with an extended expiration date of December 2023 or later are encouraged to return it to Pfizer before December 31, 2023, to facilitate a credit to the U.S. government. These credits will be allocated to the Patient Assistance Program, not the returning facility. Facilities with excess unexpired USG inventory of molnupiravir are encouraged to continue dispensing it to patients until depleted or expired.
For both treatments, the USG-distributed supply can continue to be utilized for any eligible patient as long as the individual EUAs remain active, and the product has not expired. Any USG-purchased supply dispensed by sites must remain available to patients free of charge.
Find Providers with COVID-19 Therapeutics
The COVID-19 Therapeutic Locator map, provided by HHS, shows locations that received shipments of U.S. Government-procured COVID-19 therapeutics under the U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) authority. The displayed locations have reported stock on hand within the last two weeks.