Starting next year, an anti-viral drug for fighting COVID-19, Paxlovid, will no longer be paid for by the federal government, shifting costs to private insurance for those who have it.

Paxlovid is highly effective at saving lives and preventing hospitalization in nearly 90 percent of cases for people who have severe disease. However, costs for the drug can run as high as $1,400 for one standard five-day course.

The maker of the drug, Pfizer, is continuing to provide it for free to people without health insurance. Yet Alabama State Health Officer Dr. Scott Harris said the steps to get that coverage for the uninsured may complicate access for Alabamians when the drug is no longer automatically free for everyone in 2024.

“I think the barriers are going to go up when there’s not just free product available automatically, but it involves this extra step of getting into a patient assistance program,” said Dr. Harris, “Which is a concern when you have a time-sensitive situation needing to start the drug within a certain window.”

Almost 12% of the state lacks health insurance according to the Public Affairs Research Council of Alabama.

Harris said Paxlovid is still the best tool to treat COVID-19 for people with higher risk.

Paxlovid must be taken early in the course of contracting COVID-19, within the first five days of symptoms, to be effective.

Dr. David Thrasher, a pulmonologist who helped bring monoclonal antibodies to the state early in the pandemic, a blood infusion treatment that helped fight COVID-19 before Paxlovid was available, said Paxlovid is still needed.

According to Thrasher, Paxlovid can reduce the risk of heart attacks and it may prevent long-COVID, a little understood condition where people continue to suffer from COVID symptoms, fatigue, and other ailments indefinitely after contracting the virus.

“I would recommend anybody who gets COVID-19 to call their provider, hopefully a provider who is very knowledgeable in this, because the Paxlovid does save lives. There’s no question about that,” he said.

The CDC says adults and children who are at high risk for COVID-19 are eligible to take Paxlovid.

Dr. David Becker, a professor in the School of Public Health at UAB, said the change will shift costs from the government to private insurers.

“For some people, this’ll lead to significant or could lead to significant increasing out-of-pocket costs. Whereas for others, the impact would be less significant and that’ll depend on the design of their insurance benefits.”

For some people costs may increase leading them to not to take Paxlovid when they previously would have, said Becker.

Alabama continues to provide free COVID-19 testing at community health centers and county health departments, for the uninsured or underinsured, Dr. Harris said.

And for people with insurance wondering about whether to take Paxlovid, he recommends Alabamians ask how their insurance will cover Paxlovid in advance of catching the disease.

“It would help to start with a pharmacy that you use if you have a relationship with one and ask them to help you,” he said. “It’s really good to have a plan in place.”