Readout of HHS Secretary Becerra’s Meeting with Pharmacies, Pharmacy Benefit Managers, and Insurers on COVID-19 Therapeutics Commercialization

Secretary Becerra highlighted the importance of access to COVID-19 therapeutics and reiterated HHS’ commitment to partnering with pharmacies and insurers to better serve the American people.

On Tuesday, January 9, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra met virtually with pharmacy leaders, pharmacy benefit managers, and insurers to discuss HHS’ continued commitment and partnership to increase equitable access to COVID-19 therapeutics.

During the call, Secretary Becerra reminded participants that no patient should be forced to pay the full out-of-pocket cost to access Paxlovid and asked that stakeholders immediately alert HHS of any issues that arise regarding COVID-19 therapeutics access. Secretary Becerra reiterated HHS’ commitment to ensuring smooth access to oral antivirals for COVID-19 and encouraged all providers to ensure patients who experience issues accessing Paxlovid or Lagevrio are directed to the designated patient assistance programs available for both antivirals. Finally, he highlighted the importance of continued provider ordering of commercially available oral antivirals and provider education.

The Biden-Harris Administration has made historic progress in our nation’s ability to manage COVID-19 so that it no longer meaningfully disrupts the way we live our lives. For the first time, vaccines are available to protect older adults in the United States against all three winter respiratory illnesses – COVID-19, flu, and RSV – and there are millions of courses of free USG Paxlovid at provider sites across the country available by the federal government. Free COVID-19 tests are also available at COVIDTest.gov.

Today’s call is part of a series of recent actions HHS has taken to maintain broad access to oral antivirals for COVID-19 as part of the transition to the commercial market:

• Since last fall, HHS, the Administration for Strategic Preparedness & Response (ASPR), the Centers for Medicare & Medicaid Services (CMS), and Pfizer have regularly met with stakeholder groups to discuss increased Paxlovid access and address other stakeholder questions around oral antivirals commercialization.
• As of October 13, 2023, HHS and Pfizer reached an agreement extending patient access to Paxlovid, maximizing taxpayer investment, and beginning Paxlovid’s transition to the commercial market. Under the October 2023 agreement, individuals - including those on Medicare and Medicaid - maintain access to Paxlovid through the end of 2024. The agreement also enables access for the uninsured through 2028, ensures that no HHS-procured product will be lost to expiry, and has ensured that Pfizer will create a stockpile for future emergencies.
• On October 27, 2023, at the outset of Paxlovid’s transition to the commercial market, Secretary Becerra wrote to therapeutics manufacturers, distributors, pharmacies, and the health care payer community requesting their partnership as therapeutics transitioned to the commercial market and asking that they inform HHS immediately if they encounter any operational problems that impede patient access to these treatments.
• On January 4, 2024, CMS released guidance for Medicare Part D plans that describes coverage and processing claims for COVID-19 therapeutics. As a reminder, Medicare Part D plans must cover commercially available oral antivirals for COVID-19, either as a formulary product or through the formulary exception process.  We expect that many Part D plans will take advantage of an agreement with Pfizer that will allow their enrollees to access Paxlovid for free through the plan without needing to enroll in Pfizer’s patient assistance program.