Prescriptions

How Much Does COVID Antiviral Pill Paxlovid Cost With and Without Insurance?

Khang T. Vuong, MHA
Khang T. Vuong, MHA20 Dec 2023
New JN.1 COVID variants
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Paxlovid Availability
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Is Paxlovid effective at treating COVID-19?
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How much is a course of Paxlovid treatment?
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Where do I get Paxlovid near me? Do I need a script from a doctor?
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What are the eligibility criteria to get Paxlovid COVID treatment?
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What should I do to get Paxlovid if I test positive for COVID?
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Paxlovid is currently being used to treat mild-to-moderate COVID-19; the treatment costs $530-$700 per person. According to the U.S. Department of health, Paxlovid distribution is still being managed by the federal government and should be prescribed at no cost to individuals with or without insurance. There is plan in place, however, to end this program by the end of the year. Paxlovid is a combination of nirmatrelvir tablets and ritonavir tablets developed and manufactured by Pzifer.

Although the FDA recently authorized pharmacists to prescribe Paxlovid without a prior prescription, the majority of pharmacies still require a prescription to dispense Paxlovid. 

According to Pfizer's recent press release on October 13, 2023, it will price Paxlovid at $1,390 per course of treatment. Notice this is the MSRP, insurance and government programs will pay much less than that. 

New JN.1 COVID variants

  • The WHO declared the coronavirus subvariant JN.1, a descendant of omicron, as a variant of interest due to its rapid spread and increased cases. 
  • Symptoms of JN.1 are similar to other COVID-19 variants, considered less severe than a variant of concern, like delta or omicron.
  • JN.1 is present in 41 countries, making up 27.1% of total cases globally, with significant case numbers in France, the United States, Singapore, Canada, the UK, and Sweden. It is currently the fastest-growing variant in the U.S.

Paxlovid Availability

Recent Updates: On October 13, 2023, an agreement was reached between HHS and Pfizer to increase patient access to Paxlovid. The FDA had earlier approved Paxlovid as the first oral antiviral for adult COVID-19 treatment on May 25, 2023.

Dosage Information: Paxlovid is available in two dosages. The standard dose consists of 300 mg nirmatrelvir with 100 mg ritonavir, taken twice daily for 5 days. A reduced dose is available for individuals with moderate renal impairment, while it's not recommended for those with severe renal impairment.

Availability and Distribution: Since December 2021, Paxlovid has been distributed for free by the U.S. government through various health entities. Starting November 2023, the U.S. government will transition to traditional commercial distribution of Paxlovid. Efforts are underway to ensure affordable access, especially for public program beneficiaries and the uninsured, and to transition smoothly to the commercial market without wastage.

Is Paxlovid effective at treating COVID-19?

The results published from a clinical trial of 2246 patients found an 89.1% reduction in the risk of hospitalization and death in the group that was administered Paxlovid no later than three days after COVID-19-related symptoms started. 

Although effective at reducing the risk of hospitalization, taking Paxlovid doesn’t wholly mitigate all COVID-19-related symptoms. Multiple anecdotal reports from patients suggest that Paxlovid makes them feel better, but symptoms like sore throat and mild fever still last between two and five days. 

Despite the recent research suggesting that Paxlovid is not effective for healthy adults, we found anecdotal evidence to suggest that Paxlovid does reduce the duration and reverse the symptoms of COVID-19 in vaccinated adults and those with less severe chronic conditions like asthma. 

How much is a course of Paxlovid treatment?

  • If you don't have insurance: Paxlovid might cost you between $530 and $700 for the full treatment.
  • If you have insurance: The price of Paxlovid can change based on your insurance. Some might pay for all of it, while others might ask you to pay a part.
  • If you have Medicare: If you've got a mild to medium case of COVID-19 and you're on Medicare Part B, they'll cover the cost. You won't have to pay anything extra.
  • If you have Medicaid: If you qualify, Medicaid will pay for Paxlovid. You won't need to pay extra.

Heads up: Right now, the government is giving out Paxlovid and Lagevrio for free with the Test to Treat program, even if you don't have insurance. But we don't know for how long they'll do this.

Though the cost of Paxlovid is free, the treatment requires a doctor’s order and the cost of the doctor’s visit depends on your insurance status. Read more about the cost of urgent care visit without insurance.

How many days do I need to be on the medication?

A Paxlovid course includes five days of treatment. Pfizer recommends two daily doses, one in the morning and one at night, with 3 pills in each dose. While on Paxlovid, you must consult your pharmacist and stop taking other medications that could cause drug interaction.

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Khang T. Vuong, MHA

Khang T. Vuong received his Master of Healthcare Administration from the Milken Institute School of Public Health at the George Washington University. He was named Forbes Healthcare 2021 30 under 30. Vuong spoke at Stanford Medicine X, HIMSS conference, and served as a Fellow at the Bon Secours Health System.

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