Jan 31, 2022

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Coverage of FDA-authorized COVID-19 antiviral medicine

We now cover the oral antiviral drugs Paxlovid and Lagevrio at no additional cost to members as part of their pharmacy benefits. Both drugs received emergency use authorization from the U.S. Food and Drug Administration (FDA) late last year. They are only available by prescription and can reduce the chance of hospitalization and potential for severe illness when taken within five days after symptoms appear.

 

During the Coronavirus Public Health Emergency, the federal government will pay the ingredient drug costs of FDA-authorized COVID-19 oral antivirals. Employers will not have to pay the ingredient drug costs and members will have no cost share for these drugs. Claims for COVID-19 oral antivirals will be excluded from rebate calculations and other client pricing guarantees for ASO clients.

 

This coverage will continue for the length of the public health emergency and is retroactive to the date of FDA authorization.

• Paxlovid was developed by Pfizer and was authorized by the FDA on December 22, 2021.
• Lagevrio was developed by Merck and was authorized on December 23, 2021.

Coverage limitations:

• Members will be limited to one course of each COVID-19 oral antiviral therapy within a 30-day window.
• Paxlovid is limited to members 12 years old or older.
• Lagevrio is limited to members 18 years old or older.
• Both medications require a prescription.

Please contact your sales representative for more information.