Insurance coverage

What will insurance coverage for COVID-19 vaccines and treatments look like? The Biden administration is trying to figure this out

Prepare for a big change in how the United States will pay for COVID-19 vaccines and treatments.

The Department of Health and Human Services is expected to hold a meeting later this month with drugmakers, pharmacies and state health departments to discuss moving coverage of pandemic therapies from the U.S. government to a market commercial, according to the Wall Street Journal.

Arpa Garay, ARNM of Moderna,
-2.70%
chief commercial officer, told investors on a recent earnings call that the company is already preparing for the shift in the COVID-19 vaccine market.

“We are ready to move into the U.S. commercial market for COVID boosters, where the market will be more fragmented than it was during the pandemic, where the U.S. government was the sole purchaser of vaccines,” she said.

Pfizer PFE,
+1.67%
told investors last month that bringing its COVID-19 products to a commercial market frees the company to expand distribution channels and run brand campaigns.

“All of these things are actually things that Pfizer does, and the Pfizer sales organization does very well. That’s our sweet spot,” Angela Hwang, Pfizer Group president of biopharmaceuticals, said in a July call. “We look forward to building on what the government has done, which has been really great, and building on that to do more and support bigger initiatives across the country.”

One of the main complications of changing how COVID-19 vaccines and treatments are paid for is figuring out how to make sure they’re still available to the 30 million people in the United States who don’t have no health insurance.

Another issue is Medicare and Medicare not paying for available therapies due to emergency clearances. While the COVID-19 snapshots developed by BioNTech BNTX,
+0.22%
/Pfizer and Moderna are now fully approved, Merck MRK,
+1.37%
and Pfizer’s antivirals are not, the Journal reported.

Other COVID-19 news to know:

The Food and Drug Administration plans to base its decision to allow a new generation of COVID-19 boosters on data from studies involving mice ⁠ — not humans, according to NRP. Adopting this approach should speed up the arrival of new shots. “For the FDA to rely on mouse data is just weird, in my opinion,” John Moore, an immunologist at Weill Cornell Medicine in New York, told NPR.

The World Health Organization on Thursday advised VALN from Valneva,
-4.25%
Two-dose COVID-19 vaccine in adults aged 18-50.

What the numbers say:

The seven-day average of new COVID-19 cases was 96,275 on Thursday, the lowest number since June 21, according to a New York Times tracker. Only four states saw case counts rise from two weeks ago: Michigan, up 15%; South Carolina, up 10%; Tennessee, up 5%; and Mississippi, up 1%. The daily average for hospitalizations was 41,256 on Thursday, down 6% from two weeks ago. The daily average of deaths is 475. — Tomi Kilgore