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Module 4: Facilitating Patient Access

Access to Oral Antivirals (OAVs)

  • Pharmacy partners are encouraged to order commercial product to ensure that there is adequate supply to meet demand for oral antivirals.
    • There should be no gap between depletion of USG-distributed product and commercial product.
  • Anyone facing difficulty in access at the pharmacy counter should be directed to the patient assistance programs available to support access to Paxlovid (PAXCESS) and Lagevrio (Merck Helps).
  • Through the Paxlovid PAP operated by Pfizer, individuals covered under federal programs, such as Medicare or Medicaid, and uninsured patients have a free access option to Paxlovid through 2024. Eligible uninsured patients have a free access option beyond 2024.
  • Commercially insured patients can access the co-pay savings program.
  • Medical professionals, pharmacy and plan partners should take steps to ensure patients understand the full range of options.
    • Guide patients to enroll – to ensure little to no cost for patient, encourage enrollment/awareness at every opportunity (eg, prior to pharmacy engagement).

Continued Access to Paxlovid

  • Medicare, Medicaid, and uninsured patients will continue to receive Paxlovid at no charge through December 2024 using the USG Patient Assistance Program (USG PAP) operated by Pfizer.
    • Includes all patients publicly insured through Medicare (with or without Part D, Part B, or Part C and inclusive of Medicare Advantage), Medicaid/CHIP, TRICARE, and patients insured through the VA Community Care Network.
    • Uses USG-procured supply (commercial, NDA-labeled).
  • Separately, federal entities (HRSA, IHS, VA, DoD, others) will have continued access to USG-procured Paxlovid supply for their patients, similar to how they have accessed Paxlovid to date.
  • USG-procured Paxlovid may also be used to support state, local, tribal, or territorial special programs targeting vulnerable populations on a case-by-case basis.
  • Reach out to your ASPR regional staff or covid19.therapeutics@hhs.gov.
  • Concurrently, Pfizer is operating a Paxlovid Co-Pay Savings Program for eligible privately (commercially) insured patients.

Continued Access to Lagevrio

  • The Merck Patient Assistance Program (a 501c3 non-profit organization) provides Lagevrio free of charge to patients who meet its eligibility criteria and who, without assistance, could not otherwise afford the product.
    • This product is ONLY available through an URGENT NEED request. Your Health Care Provider must call 800-727-5400 and tell the program representative that they are making an Urgent Need Request for LAGEVRIO. The program representative will provide necessary instructions. Your Health Care Provider must follow the program representative's instructions to make your request. You may also check your eligibility on MerckHelps.
  • In addition, USG-procured Lagevrio will continue to be distributed to certain federal entities, including HRSA-supported health centers, Indian Health Service, and others until USG supply is depleted.