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Important Coverage Change for Paxlovid

Paxlovid is a COVID-19 antiviral medication.

Recently there has been an increase in the number of COVID-19 cases across the nation. If your prescriber is contemplating or has prescribed Paxlovid for your COVID-19 diagnosis, please be aware of this important change in the coverage for Paxlovid in 2024.

While the anti-virals used to treat and reduce the symptoms of COVID-19 are still available, the government will no longer be supplying these medications for $0 cost share to Medicare members as they had in 2023. In late 2023, the federal government stopped supplying government procured Emergency Use Authorization (EUA) Paxlovid to pharmacies. While some pharmacies may still have some of this product in stock, the distribution of the Paxlovid product has changed to commercial Paxlovid which is the FDA-approved, New Drug Application (NDA)-labeled product. This means that normal copays for the commercially labeled medications will apply based on the formulary coverage. Paxlovid is currently covered on the formularies for the Enhanced, Basic, and Value Medicare Rx Options. Members who receive the commercial supplied stock will be charged the normal Tier 3 copay. If you are enrolled in one of the Medicare Advantage plans under the Health Options Program, please check the formulary for the plan to confirm coverage.

However, Pfizer, the manufacturer of Paxlovid, has implemented a Patient Assistance Program (PAP) in 2024 called PAXCESS to reduce the out-of-pocket costs for the Commercial Paxlovid anti-viral to $0 for patients that enroll in their program. In order for you to receive Commercial Paxlovid for a $0 cost share at your pharmacy, you must enroll in the program and alert the pharmacy staff of this enrollment. If you do not enroll prior to obtaining your prescription at the pharmacy, ask your Pharmacist or pharmacy staff about enrolling while you are there to receive the Commercial Paxlovid medication at no cost.

More information about the Paxlovid PAXCESS program can be found at https://www.paxlovid.com/paxcess.

To enroll in the PAXCESS program, call 1-877-219-7225 or visit the PAXCESS Patient Portal at https://paxlovid.iassist.com/.

To review drug coverage under the Enhanced, Basic, or Value Medicare Rx Option, visit the Prescription Drug Coverage page.

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