Does My Plan Cover Paxlovid?

Paxlovid continues to be recommended for those who are at higher risk of becoming very sick from COVID, largely those whose immune systems are compromised and older Americans.

We recently learned that Paxlovid, the most commonly prescribed anti-viral for those who have COVID, is not covered by Medicare Part D plans this year. That may be because Paxlovid is provided at no charge through a government patient assistance program called Paxcess which is operated by Pfizer for those on Medicare, Medicaid, or other government-sponsored coverage.

You must enroll in this program prior to filling a subscription in order to benefit from this program. Paxlovid is expensive without coverage so please take note of this information. If you are on Medicare, Medicaid, or are uninsured, go to paxlovid.com/paxcess or call 877-219-7225 to obtain Paxlovid free of charge.

We believe that Pfizer is also providing a copay assistance program for those with commercial insurance. In order to access the program, it appears that one goes to Paxlovid.iassist.com. Unfortunately, you can only advance with that site if you already have a prescription for Paxlovid and then you are prompted to enter your personal information. If you have difficulty using a website and would like to reach an individual, the number for the Pfizer Information Center is 877 219-7225.

Our limited research suggests Paxlovid remains on the formularies of individual and group plans. As with other drugs, actual prices and copay amounts can vary depending on your coverage. I have large group coverage so I accessed my Caremark site to determine what my copayments would be if Paxlovid were prescribed. I learned that for a five-day supply, my plan would pay $1,191.25 for a Paxlovid prescription and I would pay a $135 copayment.

Another issue to remember is that there is a long list of drugs that if one is taking Paxlovid is contraindicated. We have included the list below from the Pfizer-sponsored site.

We hope this information is helpful and that this winter doesn’t lead to serious flu, COVID, or other respiratory problems for most of us. However, should you be prescribed Paxlovid, do your homework if you don’t want to overpay for the drug.