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Coverage of Antiviral Agents Paxlovid and Molnupiravir hero image

Coverage of Antiviral Agents Paxlovid and Molnupiravir

Recently, the FDA approved the first COVID-19 oral antiviral agents. Pfizer’s Paxlovid® (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) and Merck’s molnupiravir have been granted emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) in the treatment of mild-to-moderate COVID-19 for people at high risk for progression to severe COVID-19. For government-procured units, payors will not need to reimburse any pharmacy for the product’s ingredient cost. Payment of pharmacy ordering or dispensing fees is not addressed by the FDA’s EUA announcement and, at this time, Medicare has not addressed the topic either. The U.S. government has already purchased enough Paxlovid for 10 million patients at a cost of $530 for each complete treatment package. The U.S. government is paying the manufacturers of Molnupiravir, Merck, and Ridgeback Biotherapeutics, $700 per regimen for the 3 million treatment courses that should become available for use sometime in January. The timeline related to availability is related to how the federal and state governments choose to distribute the medication.

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