COVID-19 oral antiviral commercialization
Starting in November 2023, Paxlovid® and Lagevrio®, oral antivirals for treating COVID-19, will be available commercially at retail pharmacies. Claims for these treatments can now be submitted to available insurance. Previously, these products were provided through the supply purchased by the federal government during the public health emergency (PHE).
Please review the following additional information regarding these treatment options.
Paxlovid (nirmatrelvir/ritonavir) — Pfizer
- First oral antiviral pill fully approved by the U.S. Food and Drug Administration (FDA) for treatment of mild to moderate COVID-19 in adults at high risk for progression to severe COVID-19
- Commercial supply will be available starting Nov. 1, 2023
- Pfizer plans to offer a $0 patient assistance program (PAP) through Dec. 31, 2024, for individuals on Medicare, Medicaid and those uninsured
- Pfizer will operate a copay assistance program for individuals with commercial insurance through 20281
Lagevrio (molnupiravir) — Merck
- Authorized by the FDA under an Emergency Use Authorization (EUA) for treatment of mild to moderate COVID-19 in adults at high risk for progression to severe COVID-19
- Lagevrio is a second-line option for those who cannot take Paxlovid or when Paxlovid is not accessible2
COVID-19 oral antiviral commercial supply coverage details
Patient cost-share depends on the oral antiviral prescribed and the member’s UnitedHealthcare plan benefit.
| Plan | Member cost-share amount | Additional details |
|---|---|---|
| UnitedHealthcare commercial plans | Paxlovid: Member’s plan-specific cost-share, subject to state mandates Lagevrio: Member’s plan-specific cost-share, subject to state mandates |
If the government supply of Paxlovid and Lagevrio is used, the member cost may be less than the standard copay. |
| Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace Plans | Paxlovid: Member’s plan-specific cost-share Lagevrio: Member’s plan-specific cost-share |
Paxlovid will remain $0 until the government supply is depleted, or until Jan. 1, 2024, whichever comes first. |
| Individual and Group UnitedHealthcare Medicare Advantage and stand-alone Part D Plans | Paxlovid: $0 cost-share through Pfizer’s PAP Lagevrio3: Member’s plan-specific cost-share |
Member cost-share for Paxlovid will remain $0 until government supply is depleted and will continue to be $0 through Pfizer’s PAP. |
| UnitedHealthcare Community Plans | Paxlovid: $0 cost-share through Pfizer’s PAP |
COVID-19 treatments will be $0 through Sept. 30, 2024, per the American Rescue Plan Act of 2021 (ARPA). |
Questions? We’re here to help
Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal. You can also call Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.
1Pfizer Amends U.S. Government Paxlovid Supply Agreement and Updates Full-Year 2023 Guidance. Accessed Nov. 14, 2023.
2Health and Human Services: Administration for Strategic Preparedness & Response. Important Update: Lagevrio prepares for transition to commercial distribution (hhs.gov). Accessed Oct. 24, 2023.
3The Consolidated Appropriations Act (CAA) allows Part D plans to cover Lagevrio through Dec. 31, 2024. After that date, Part D coverage will require FDA approval. Understanding Coverage Considerations for COVID-19 Vaccines and Treatments (aspe.hhs.gov). Accessed Oct. 27, 2023.
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