Why you should pay for your COVID-19 test now

(The Hill) – The federal government is poised to stop paying for COVID-19 vaccines, tests and treatments in the coming months and pass the costs on to the public.

Most Americans don’t realize this is going to happen, and it will be a big case of sticker shock, according to experts. It warns that the shift to preventive services will lead to health barriers.

“How we do it in the US [right now] In fact, it’s more like how much healthcare works in other countries. But once the public health emergency is over, it will be as complex and costly as healthcare in the United States,” said Cynthia Cox, insurance expert and vice president of the Kaiser Family Foundation. says. .

Instead of free access to tests and treatments like Paxlovid, insurance companies and manufacturers set the price.

The days of free and easily accessible COVID-19 tests are about to end. Private insurance may no longer cover over-the-counter testing, and patients may first need a prescription for PCR testing.

Sabrina Corlett, research professor and co-director of the Georgetown University Center for Health Insurance Reform, said:

Costs may be reflected in insurance premiums, but the vaccine will continue to be free for those with private insurance. Even with insurance, it can be expensive for patients to go to out-of-network providers.

But the biggest impact will be on uninsured or underinsured Americans, many of whom have jobs that put them at high risk of exposure to COVID-19.

“Uninsured adults are out of luck,” Jen Cates, director of global health and HIV policy at the Kaiser Family Foundation, said at a briefing last month. access to testing and treatment in new settings cannot be guaranteed.”

The end of the US government’s public health emergency declaration and the depletion of federally purchased supplies.

The Biden administration extended the public health emergency for 90 days on Oct. 13, but it is expected to be the final extension. The Centers for Medicare and Medicaid Services told health care providers in August to start preparing to return to pre-pandemic rules as soon as possible.

Officials at the Department of Health and Human Services (HHS) said they would give 60 days’ notice to lift the public health emergency, with a deadline of Nov. 12.

The White House has asked Congress to provide billions more to fund a steady supply of COVID-19 vaccines and treatments, but lawmakers have shown no willingness to do so. .

The federal government expects funds to purchase and distribute vaccines to run short as early as January, and expects supplies of therapeutics to dry up by the end of 2023, depending on the specific product. .

Government officials have said the plan has always been to reduce federal involvement in the procurement and distribution of COVID-19 measures, especially now that supplies are no longer constrained. to the private market.

“Whether we get COVID funding or not, we eventually had to make this transition at some point. Dawn O’Connell, assistant secretary of preparedness and response for the WHO, said at a news briefing last month hosted by the Kaiser Family Foundation.

O’Connell said the government is coordinating with manufacturers to ensure there are sufficient supplies of tests, treatments and vaccines on hand to bring them to the commercial market when government involvement ends. said.

“Many of the supplies were sent to the U.S. government. will come

“If we can afford to buy these while manufacturers continue to grow, we can easily adjust that. Without the funding, we may not be able to do that.”

Health experts and advocates have expressed concern that drug companies might start charging exorbitant prices without federal involvement.

Pfizer has quadrupled the cost of its COVID-19 injections and said it plans to charge between $110 and $130 per shot, probably by early next year, once the government contract ends.

Eli Lilly’s monoclonal antibody therapeutics are sold directly to providers at a list price of $2,100 per dose, but may be ineffective against some new Omicron subspecies.

As prices rise, consumers with private insurance may face tiered benefits to limit access or determine medical need.

For those without insurance, the barriers can be huge. And if the infection spikes in winter, it could have serious consequences.

“If we had another surge, it could be a real problem,” Corlett said. “Testing services will probably not be as widespread. People will face cost sharing, even those without insurance … will have to pay for tests and vaccines out of their own pocket. It’s a terrifying situation.”

Certain health care providers, such as community health centers, may offer services at a discounted price or for free, and HHS’ O’Connell said the government is working with manufacturers on how to ensure uninsured people maintain access. He said they are cooperating.

But the Biden administration doesn’t have many tools at its disposal.

“There is no dedicated program. [the uninsured] — rather, we go back to the imperfections of the U.S. healthcare system,” Cates said in an email.

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