Counsel your patients on these programs when prescribing antivirals and help them enroll or provide them with the necessary information to do so to avoid unnecessary costs or delays in treatment.

Nirmatrelvir/Ritonavir (Paxlovid) Coverage and Access Programs

Find provider resources and patient education materials at Pfizer: Paxlovid Access.

Uninsured and Medicare/Tricare (through 2025)

• Patients must enroll in Pfizer’s Paxcess Patient Assistance Program before picking up their prescription to avoid out-of-pocket costs.
• To enroll, the patient, caregiver, provider or pharmacist can visit PAXCESS Patient Portal or call 877-C19-PACK (877-219-7225) to complete a short application.
• Once approved, information will be provided on how and where to pick up the prescription. Prescriptions must be filled at a Paxcess participating pharmacy, which can be found at the Paxcess website.
• Patients will not be reimbursed for out-of-pocket costs if they do not enroll in the Paxcess program.
• Patients also have the option to request overnight mailing of the prescription via FedEx (Sundays excluded) by calling 877-219-7225.

Medicaid/CHIP

• New York State Medicaid (NYRx) covers Paxlovid with the standard co-pay.

Commercial Insurance

• Most commercially insured patients are eligible for co-pay assistance via Pfizer’s Co-Pay Savings Program.
• Patients can go to Paxcess or call 877-219-7225 to enroll in the Co-Pay Savings Program before picking up the prescription at any pharmacy (not limited to pharmacies enrolled in Pfizer’s Paxcess program).
• Patients who have already paid a co-pay for Paxlovid may be eligible for a reimbursement. Information and forms are available at Paxcess.

Molnupiravir (Lagevrio) Coverage and Access Programs

Since molnupiravir (Lagevrio) is only authorized under an Emergency Use Authorization, some health plans, including Medicaid, may not cover or will require prior authorization.

Uninsured or if Medication Not Covered by Health Plan

• Merck has a Patient Assistance Program available for people without health insurance. Visit Merck Helps: Lagevrio for more information on eligibility.
• To enroll patients in the program, a provider must call 800-727-5400 and tell the program representative that they are making an Urgent Need Request for Lagevrio for their patient. The program representative will provide further instructions.
• If approved, Lagevrio will be shipped overnight to the patient’s address.

Medicaid

• New York State Medicaid (NYRx) does not cover lagevrio.
• Providers must call the Merck patient assistance program at 800-727-5400 to make a request on behalf of the patient (see above).

Medicare and Commercial Insurance

• Lagevrio coverage varies. Patients should check with their pharmacy and health plan about coverage and co-payment costs. Prior authorization may be required.
• Commercially insured patients may still be eligible for co-pay assistance. Visit Lagevrio: Coupon Offer to apply.
• If a health plan does not cover Lagevrio or if the patient cannot afford the co-pay, insured patients may still qualify for the Patient Assistance Program if they attest to special circumstances of financial and medical hardship and their income meets program criteria. Providers should call 800-727-5400 to check eligibility.

Remdesivir (Veklury) Access Programs

Uninsured

• For patients treated in the outpatient setting, a Patient Assistance Program is available for people without health insurance. Visit Gilead's Advancing Access Program or call 1-800-226-2056 for more information on eligibility.

Insured

• For patients with commercial or private insurance, there is a co-pay program.
• The Advancing Access Program can provide support with prior authorization and appeals process information.

People at increased risk of severe COVID-19 and their caregivers should be advised:

• About the benefits of prompt oral antiviral treatment to reduce the risk of hospitalization and death
• To immediately get tested if they develop COVID-19 symptoms or were recently exposed
• To contact their provider right away if they test positive
• That COVID-19 rebound is generally mild and does not represent a treatment failure or resistance