Key Takeaways

Paxlovid, a drug that can help prevent severe illness and death from COVID-19, has been cost-free for anyone, regardless of health insurance coverage, since it was first authorized in 2021. But that will change on November 1, when the drug moves from the public to the commercial market.

The move is a result of the conclusion of the COVID Public Health Emergency, declared at the start of the pandemic and lifted in May, Priya Nori, MD, an infectious disease specialist at Montefiore Medical Center in New York City, told Verywell.

What the End of the COVID-19 Public Health Emergency Means For You

Still, some glitches regarding cost and coverage are expected in the first few days and weeks of the transition. Not all details are available yet, but here is what we know so far.

New Patient Assistance Programs Are Rolling Out

Together,HHS and Pfizerhave announced patient assistance programs that will provide Paxlovid for free to people on federal insurance programs such as Medicare and Medicaid until at least the end of 2024. These programs will also cover the cost of the drug for people without insurance and most of the copay for people who are “underinsured”—that is, have a copay they can’t afford.

Federal Insurance Programs

Copay Assistance for Private Insurance

Pfizer has information on its website about enrolling in its newCo-Pay Savings Program. If you are eligible, you will be able to immediately download a card to share at the pharmacy, though expect to get the drug for free regardless if you are filling a prescription before the end of the year. After that, insurers may ask patients to pay for a portion of the drug. Under the Pfizer assistance program the most you will pay out of pocket is $140 for your prescription.

Where Can You Get Paxlovid Now? Are You Eligible for the Medication?

Other Ways to Get Paxlovid for Free or Cheap

While the official cost savings programs get up and running, there are two main methods you may be able to use to get Paxlovid for free quickly. Speed matters; Paxlovid must be taken within five days of COVID symptom onset in order to be effective,Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Verywell.

Molnupiravir vs. Paxlovid: Which Is Better for COVID-19?

Certain clinical trial participants can get Paxlovid quickly, too. With the help of a testing firm called eMed, the National Institutes of Health (NIH) is running a clinical trial evaluating at-home testing for COVID-19 that includes free Paxlovid if you test positive and are eligible for the drug.

Many people can register online for eMed’sHome Test to Treatprogram at any time and receive six at-home COVID rapid tests if accepted. Regardless of insurance status, anyone can upload the results of any COVID test, whether PCR or antigen and whether from eMed or not. In the event of a positive test, you’ll be able to connect with a telehealth provider for free who will determine if you are eligible to take Paxlovid. You’ll need to share any medications you take, since several drugs interact with Paxlovid.

If you are eligible for Paxlovid, the physician can send a prescription to a local pharmacy, which may charge a dispensing fee that can range from a few cents to $20,Michael Mina, MD, PhD, chief science officer at eMed, told Verywell. “Patients who qualify for Paxlovid can also have the drug sent overnight with no cost for shipping or the medication,” he added.

Who Is Eligible for Paxlovid?Only people age 12 and older who are considered at high risk for severe disease from COVID-19 are eligible for Paxlovid. This includes people with underlying health conditions like asthma, diabetes, chronic lung disease, and chronic kidney disease.Even if you meet these criteria, it’s important to know thatmany medicationsare not safe to take alongside Paxlovid. If you need an antiviral treatment but are taking a medication that makes Paxlovid unsafe, you may be prescribed Lagevrio instead.

Who Is Eligible for Paxlovid?

Only people age 12 and older who are considered at high risk for severe disease from COVID-19 are eligible for Paxlovid. This includes people with underlying health conditions like asthma, diabetes, chronic lung disease, and chronic kidney disease.Even if you meet these criteria, it’s important to know thatmany medicationsare not safe to take alongside Paxlovid. If you need an antiviral treatment but are taking a medication that makes Paxlovid unsafe, you may be prescribed Lagevrio instead.

Only people age 12 and older who are considered at high risk for severe disease from COVID-19 are eligible for Paxlovid. This includes people with underlying health conditions like asthma, diabetes, chronic lung disease, and chronic kidney disease.

Even if you meet these criteria, it’s important to know thatmany medicationsare not safe to take alongside Paxlovid. If you need an antiviral treatment but are taking a medication that makes Paxlovid unsafe, you may be prescribed Lagevrio instead.

Rapid Tests Are Barriers to Paxlovid, Too

The current transition to the commercial market is not the only issue that could make it hard for people who might benefit from Paxlovid to access the drug within the five-day eligibility period. A recent study published in the journalClinical Infectious Diseasesfound that since so many people have had a COVID vaccine and/or at least one COVID-19 infection, our immune systems are better primed against the disease. An infected person’s viral load might not rise sufficiently enough for them to test positive on an at-home rapid test until the fourth day of symptoms.

But you may also test negative on a COVID test because you don’t have the virus and therefore don’t need Paxlovid. In fact, if you have flu, people at risk of severe illness need different medication, which has to be started within 48 hours of symptoms in order to be effective.

“If somebody is at high risk for severe COVID and has symptoms consistent with COVID, but is testing negative on a home antigen test, I would suggest being tested for other illnesses as well as getting tested for COVID with a PCR, test,” Adalja said.

Chris Chao, MD, president of the College of Urgent Care Medicine, told Verywell that the PCR test for COVID-19, a more sophisticated test that you can get at a doctor’s office or clinic, has remained more effective than rapid tests over the course of the pandemic. While results used to take days, they now take just a few hours, “which can lead to a quick Paxlovid prescription if it’s warranted,” Chao said.

What This Means For YouIf you’re having trouble getting free or low-cost Paxlovid, know that temporary challenges are expected as the drug becomes commercially available for the first time. Pharmacies and clinics are working to update insurance coverage information.People with private or federal health insurance are likely to get the drug for free or a small copay if they are eligible for it. If, after November 1, your doctor prescribes Paxlovid and the pharmacy is charging a copay that you can’t afford, you’ll be able to call the company that makes it to ask about copay and payment assistance programs. Call 1-877-219-7225 or download a copay cardhere.

What This Means For You

If you’re having trouble getting free or low-cost Paxlovid, know that temporary challenges are expected as the drug becomes commercially available for the first time. Pharmacies and clinics are working to update insurance coverage information.People with private or federal health insurance are likely to get the drug for free or a small copay if they are eligible for it. If, after November 1, your doctor prescribes Paxlovid and the pharmacy is charging a copay that you can’t afford, you’ll be able to call the company that makes it to ask about copay and payment assistance programs. Call 1-877-219-7225 or download a copay cardhere.

If you’re having trouble getting free or low-cost Paxlovid, know that temporary challenges are expected as the drug becomes commercially available for the first time. Pharmacies and clinics are working to update insurance coverage information.

People with private or federal health insurance are likely to get the drug for free or a small copay if they are eligible for it. If, after November 1, your doctor prescribes Paxlovid and the pharmacy is charging a copay that you can’t afford, you’ll be able to call the company that makes it to ask about copay and payment assistance programs. Call 1-877-219-7225 or download a copay card

here.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

3 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Department of Health and Human Services.Letter to COVID-19 therapeutics manufacturers, distributors, pharmacies and the health care payer community.

Frediani JK, Parsons R, McLendon KB, et al.The new normal: delayed peak Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) viral loads relative to symptom onset and implications for Coronavirus Disease 2019 (COVID-19) testing programs.Clin Infect Dis. Published online September 28, 2023. doi:10.1093/cid/ciad582

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