The U.S. Government Patient Assistance Program, which helps those without commercial insurance get Paxlovid for free, will come with added income verification requirements for patients starting in 2025, including verification of income eligibility.
The program will continue to allow patients with Medicare drug plans who are prescribed Paxlovid to receive the medication at no cost through Feb. 28, 2025 using the existing USG PAP workflow. The current process is that some plans signed an agreement with Pfizer for zero cost share at the pharmacy counter while patients with plans that still have cost sharing can enroll in the USG PAP and provide that processing information to the pharmacy.
On March 1, the USG PAP will require program enrollment due to the end of the rebate arrangement. Under-insured Medicare patients with high copays for Paxlovid that they can't afford because of their income may be eligible for no-cost Paxlovid. Medicare patients without prescription coverage who can't afford it may also qualify for no-cost Paxlovid. Those patients that meet 300 percent of the federal poverty level will qualify.
Starting on Jan. 1, those covered under Medicaid, Tricare, or Veterans Affairs Community Care Network may be eligible for no-cost Paxlovid, if they have high copays and can't afford the medication.
This is important information as SARS-CoV-2 detected in wastewater sampling took a sharp turn up in a few regions of the country after Thanksgiving gatherings. The Administration for Strategic Preparedness and Response has a new treatment locator map. An FAQ on the page includes instructions for pharmacies that wish to appear on the locator.
