Does Medicare Pay For Paxlovid?
Covid-19 treatments have come a long way since the start of the pandemic. Today, effective medications, like Pfizer's Paxlovid can help your immune system fight the virus. But these treatments come with high price tags! Paxlovid costs up to $1,656 for a five-day course, while an alternative treatment, Lagevrio, costs about $990.
Let's look at what Covid-19 treatments Medicare covers and how to access these medications when you need them.
What is Paxlovid?
Paxlovid combines two antiviral medications: nirmatrelvir and ritonavir. These medications work together to stop the Covid virus from multiplying, slowing its progression. Nirmatrelvir helps stop SARS‑CoV‑2 (the coronavirus that causes Covid) from multiplying in your body. Ritonavir helps nirmatrelvir last for longer to ensure it’s effective.
Paxlovid is an FDA-approved drug used to treat adults and children over 12, who have mild to moderate Covid-19 and are at risk of getting sicker. Paxlovid is not intended to prevent the disease.
Doctors direct most people to start taking Paxlovid within 5 days of having Covid-19 symptoms. The recommended dosage is 3 pills (2 nirmatrelvir pills and 1 ritonavir pill), taken by mouth, twice a day for 5 days.
How do you get Paxlovid?
Physicians prescribe Paxlovid to those at risk of developing a serious case of Covid. Those at greatest risk of serious illness are those who:
Are over 50
Have underlying conditions like cancer, diabetes, obesity, or heart disease
Smoke
Are unvaccinated or behind in Covid shots
Have physical, mental, and developmental disabilities
Another way to get this prescription drug is to visit a participating pharmacy with authorized, state-licensed pharmacists, an urgent care center, or a Test to Treat Center.
While home Covid-19 testing may indicate you have Covid, a positive result means you should see a doctor, who might prescribe Paxlovid after additional testing.
A medical professional always needs to weigh in on whether prescribing Paxlovid is the right treatment. While the drug offers effective treatment for most people, it is known to interact with other drugs that seniors often take, such as statin (a cholesterol drug). Those with kidney problems should take a lower dose, while those with severe liver disease should not take it at all.
How Medicare pays for Paxlovid
Medicare Part D, which provides prescription drug coverage, typically covers Paxlovid. Unlike Original Medicare (Parts A and B), Part D helps reduce your prescription drug costs. You can get Part D coverage either through a standalone prescription drug plan or as part of your Medicare Advantage plan.
Medicare also helps reduce costs for other Covid testing and treatment needs. Learn more about Covid and Medicare coverage.
If you have Part D coverage but find the copays too expensive, or if you don't have prescription drug coverage at all, you may be able to get Paxlovid at no cost through Pfizer's U.S. Government Patient Assistance Program (USG PAP). This program helps ensure that people who need Paxlovid can access it regardless of their ability to pay.
Are there alternatives to Paxlovid?
Paxlovid is one of several treatments for Covid-19.
Lagevrio (molnupiravir), made by Merck, is an oral antiviral that stops the virus from replicating itself by introducing errors into the virus's genetic code. This prevents it from replicating effectively. While Paxlovid is considered the preferred antiviral treatment for Covid, Lagevrio is popular among those who cannot take Paxlovid.
Another alternative is Veklury (remdesivir), which is made by Gilead Sciences. Veklury is an antiviral medication administered intravenously to stop viral replication. The Food and Drug Administration (FDA) approved the drug in October 2020 for those over 12 years of age.
Do the expanded treatment options make Covid-19 vaccines unnecessary?
Covid-19 vaccination continues to offer significant protection against contracting Covid. It also helps to prevent severe illness, hospitalization, and death due to Covid. New vaccines and boosters are created to fight against new Covid-19 variants. The CDC suggests getting boosters to avoid severe illness from new Covid variants.
Where can I get more information on Paxlovid and Covid-19 treatments?
Centers for Disease Control and Prevention (CDC): The CDC website provides the most comprehensive information on Covid-19 prevention and treatments, including guidelines for healthcare providers.
National Institutes of Health (NIH): The NIH website offers detailed information on Covid-19 research, treatment options, and clinical trials.
Have more questions about Medicare coverage of Covid-19 treatments? Speak with one of our independent Medicare Advisors, who are eager to help you understand your coverage and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.