A health care worker prepares a dose of the Pfizer-BioNTech Covid-19 vaccine at a immunization clinic at the Peabody Institute Library in Peabody, Massachusetts on Wednesday, January 26, 2022.
Vanessa Leroy | Bloomberg | Getty Images
For now, uninsured Americans will continue to have free access to Covid-19 vaccines even after the US public health emergency has ended.
The Biden administration on Thursday lifted the three-year-old state of emergency that had allowed the government to provide improved welfare benefits and free Covid vaccines, testing and treatment during the pandemic.
But the availability and cost of these vaccines are actually determined by the federal government’s provision of free vaccinations, not the public health emergency.
That means people with or without insurance don’t have to pay for the Covid vaccinations out of their own pocket while supplies last.
According to the Centers for Disease Control Prevention, providers of government-purchased Covid vaccines cannot charge their patients or deny them vaccinations based on a person’s insurance status.
The Biden administration ordered 171 million Omicron Covid boosters last July. Since then, about 56 million Omicron shots have been administered, according to the CDC.
This means that more than 100 million free recordings are available to the public. The government estimates that supplies could last until the fall.
“There are many, many cans left.”. As you know, the uptake of booster shots hasn’t been very good,” said Jen Kates, senior vice president of KFF, a health policy research organization.
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But the vast majority of Americans will not have to pay for the Covid vaccines out of their own pockets, even after federal supplies run out.
The government will shift distribution of Covid vaccines to the private market once that stock runs out.
That means vaccine manufacturers Pfizer And Modern will sell their vaccines directly to healthcare providers for around $130 per dose — a nearly five-fold increase from current prices.
Insured Americans can access Covid vaccinations as part of their insurance coverage without having to pay for them out of pocket.
Private insurers and the state Medicare and Medicaid programs are required to cover all CDC-recommended vaccinations.
But for uninsured Americans, federal and corporate programs aim to close the gap.
There are still unanswered questions about what that effort will look like.
Here’s what we know about these programs so far:
Vaccines for Children program.
The CDC Vaccines For Children program is providing free Covid vaccines to children whose families or caregivers cannot afford them after the vaccines make it to the commercial market.
Children 19 and younger who are uninsured, underinsured, or eligible for Medicaid are eligible for the permanent VFC program.
This program already offers free vaccinations for other diseases, like measles and chicken pox.
The CDC’s decision to add Covid vaccinations to the free immunization program will be critical in maintaining access for many children – particularly those who are no longer eligible for other programs.
According to a report by the Department of Health and Human Services last year, up to 5 million children are expected to lose their health coverage through Medicaid or the children’s health insurance program without a public health emergency.
HHS Bridge Access Program
The Biden administration proposed creating a permanent program similar to the VFC for uninsured adults who cannot afford Covid vaccines and immunizations for other diseases. However, Congress has not yet enacted this proposal.
Meanwhile, the government last month launched the “HHS Bridge Access Program,” a temporary measure that will make free Covid vaccinations and treatments available to uninsured Americans once those products hit the commercial market.
Under the agreement, the CDC will continue to buy Covid vaccines at a discount and distribute them through 64 state and local health departments.
This HHS effort will leverage drugmakers’ “public obligations” to provide free Covid vaccines and treatments to uninsured people. As part of these obligations, HHS expects manufacturers to ship syringes directly to pharmacies free of charge.
Kates said HHS appears to be referring to the newly announced patient assistance programs from Pfizer and Moderna, which are committed to providing free Covid vaccines and treatments to uninsured people.
“As far as I know, HHS is essentially saying it will pay pharmacies the cost of administering vaccines and treatments to the public, while manufacturers will provide free vaccines and treatments directly to pharmacies as part of their patient assistance programs,” he said Kate’s to CNBC.
Pfizer and Moderna didn’t say if they would supply free vaccines to pharmacies.
Overall, Kates said the Bridge Access Program will “certainly help some uninsured Americans,” but added that it’s still “difficult to estimate” how many people would benefit and how long the program will last.
The Pfizer and Moderna programs
Pfizer and Moderna both intend to launch patient assistance programs for their Covid shots, but the companies have shared few details about those efforts.
In patient-assistance programs, pharmacies and other vaccine providers typically pay a company for a drug up front, according to Claire Hannan, executive director of the Association of Immunization Managers.
She said those providers can then apply to the program for reimbursement of the cost of that drug after administering it to an eligible patient.
Pfizer’s patient assistance program will allow eligible, uninsured Americans free access to its Covid vaccine once the vaccines hit the commercial market, according to a company spokesman. Pfizer already has a support program for its other drugs.
The company will share more information on the utility’s application process and eligibility guidelines as it becomes available, the spokesperson added.
Moderna announced in February that its patient assistance program would go into effect after the public health emergency ends.
The company did not immediately respond to CNBC’s questions about further details of the program.
Lawmakers and health policy experts have strongly criticized patient support programs for being difficult to access and understand.
A 2018 study found that providers don’t always know which patients are best suited for these programs due to a lack of clear information about eligibility and benefits.
Hannan said companies need to ensure people without insurance have easy access to a free Covid shot through their patient assistance programs.
“If you make it challenging and have them jump through multiple hurdles, vaccine uptake probably isn’t going to be what we would like,” Hannan told CNBC.