Since the explosion of COVID-19 on the world stage earlier this year, questions about the development of a pandemic-ending medicine have dominated headlines — but the cost of a coronavirus vaccine or treatment could be more than most individuals can afford.
Biotech pharmaceutical firm Gilead announced earlier this year that the necessary dosage of its coronavirus drug remdesivir would cost hospitals over $3,100 per privately insured individual. Given that 39 percent of Americans can’t even afford a $1,000 setback, and that 10 percent of the country is currently uninsured, these costs are prohibitively high for millions of individuals.
Concerns about the price for coronavirus treatment, including a much discussed COVID-19 vaccine, have weighed on the minds of many Americans, who are wary of the “real” cost. And even with the health-care provisions of the Coronavirus Aid Recovery and Economic Security (CARES) Act in place, confusion abounds over why COVID treatment is so expensive.
With nine pharmaceutical front-runners in the race to create a COVID-19 vaccine, and two already found to be over 90 percent effective in preventing the virus, it’s likely each company will seek to undercut one another to market their treatment at the most affordable (and attractive) price
Here we’ve broken down the real cost, and how much you can expect to pay, whether or not you’re insured, when additional coronavirus medical treatments roll out in early 2021.
How Much Is Coronavirus Treatment?
The cost of COVID-19 treatment varies widely based on an individual’s risk factors, including their age and pre-existing conditions (specifically whether they’re immunocompromised).
For example, an individual covered by Medicare can expect to have in-patient medical services, home health visits, physician visits, and emergency room visits covered by their insurance, per the details of the CARES Act.
Comparing this free or low-cost bill to the $400,000 bill one New York City woman received for care, and that disparity becomes even wider.
“The treatment for COVID 19 and the price for this is vastly different depending on how much equipment and treatment you require,” says general practitioner Giuseppe Aragona of remote pharmacy company PrescriptionDoctor.
“Those who are dealing with the virus at home will be able to simply pay out for some medication to help with the breathlessness and fevers, but for those who have to have a stay in hospital, it will unfortunately be a lot more money.”
What Determines How Much I’ll Pay for Treatment and Testing?
That boils down to the type of insurance you have.
While you may be accustomed to paying the out-of-pocket costs until you’ve met your deductible, and afterward only making co-payments (or paying a percentage of post-deductible costs in the form of coinsurance), the cost of COVID-19 is highly subjective.
This is due primarily to the legislation surrounding this disease — such as the CARES Act as well as the Families First Coronavirus Response Act (FFCRA), which requires that most insurers cover testing when it’s “medically necessary.”
In some places, like New York City, testing is free regardless of what insurance you carry — you can currently get tested at any number of doctors’ offices or health clinics for any reason, free of charge. Elsewhere in the country, insurers have contested their obligation to reimburse hospitals for testing when individuals get tested under certain, “non-necessary” circumstances (such as immediately following participating in a protest).
Likewise, there’s a degree of ambiguity when it comes to treatment — while some health-care providers (such as those within the insurance trade group America’s Health Insurance Providers) have waived co-payments, deductibles, and the cost of hospital stays for coronavirus treatment, other providers, and some self-funded plans, may require you to foot at least part of the bill should you become infected.
And the cost of inpatient COVID-19 care can run anywhere from $9,763 to $20,292, according to a study by health policy nonprofit the Kaiser Family Foundation (KFF).
Given that the “real” cost of COVID-19 is contingent upon your insurance, it may help to call your health-care provider to clarify what’s covered.
Calling ahead can help you take the steps necessary to reduce your total hospital bill, whether that means seeking care at only in-network facilities or getting tested before the reimbursement period lapses, ensuring you get the treatment and testing necessary at the lowest cost.
Additionally, uninsured individuals are supposed to have all costs covered through a provision of the CARES Act, which enables hospitals to be reimbursed by the federal government for the cost of treating individuals without insurance. However, concerns linger about the fact that the hospital retains the right to charge patients for care, how much in funding remains for said coverage, and which healthcare providers are offering no-cost COVID-19 treatment.
How Much Would I Pay for Remdesivir?
The “real price” of remdesivir for individuals receiving it as treatment seems to still be very much up in the air. A press release from the Department of Human Health and Services indicated that individuals with insurance should not anticipate paying the $3,100 plus price tag in full, should they receive treatment.
“Generally, patients do not pay directly for hospital-administered drugs like remdesivir,” according to the release published in June. “Rather, for Medicare and most private insurers, the drug’s cost is incorporated into payments made by the insurer, such as Medicare paying for the drug through a diagnostic-related group.”
In essence, this means that individuals may see their premium payments go up, but will not have to foot the entire cost of remdesivir themselves — though it’s possible that in meeting their health insurance plan’s deductible that they could spend quite a bit of it, depending on their insurance coverage.
“Gilead indicated it would charge $3,120 for patients with private insurance, $2,340 for Medicare and Medicaid recipients,” says health-care policy expert Ted Chan, founder and CEO of physician-review website CareDash. “We anticipate Medicare will cover 80 percent of the cost, and that private insurance will probably categorize it in a higher specialty co-pay category, a common price for which ranges between $150 and $200.”
Even with this added co-pay, however, the cost of remdesivir is far less than the cost of hospital inpatient care, given that intense cases of COVID-19 can leave an individual bedridden and receiving care for 10 to 13 days, according to the Centers for Disease Control and Prevention.
But even this efficacy is debatable — while one study from the New England Journal of Medicine found the prescription drug to be effective in shortening the recovery period for adults, the World Health Organization issued a statement in mid-November recommending against its usage.
Regardless of a patient's course of treatment , the cost of coronavirus treatment for individuals without insurance is supposed to paid for by the hospital (who will in turn be reimbursed by the government), though depending on the situation it’s entirely possible an uninsured individual could end up footing the cost of their remdesivir prescription (or more).
As such, uninsured individuals should double-check their care provider is a participant in the (lengthily titled) COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured Program prior to seeking out treatment or testing.
How Much Will a Coronavirus Vaccine Cost?
Keep in mind that the earliest we’re likely to see a coronavirus vaccine is early next year, according to Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, so speculation over the cost of said vaccine may still be premature.
However, we can estimate that the price of a vaccine will likely be subject to the same market-based competition we’ve seen in the past.
“In the long run, COVID-19 vaccines would likely begin to lower in price if they’re continuously needed,” says Chan. “This is especially true if multiple competitive pharmaceutical companies are successful in developing a COVID-19 vaccine.”
The FFCRA requires private insurers and Medicare to cover the cost of COVID-19 vaccination if it is recommended for the individual by a medical professional. Out-of-pocket costs for the uninsured, like other treatment options, remain somewhat unclear as of yet; low prices, however, are required for a vaccine to be effective.
“Vaccines need to be affordable, as many people need them in order for them to work,” says Dr. Aragona. “And this vaccine will not work if it is expensive, and only those with insurance or well-paying jobs can get it.”
Will the Government Lower the Prices?
That remains a billion dollar question, and it’s hard to say.
It’s entirely possible the federal government will step in to prevent egregious price-gouging in the event that one company maintains a vaccine monopoly, but with the pandemic already well into its eighth month, it seems increasingly unlikely that a universal, no-cost health-care program for novel coronavirus will emerge.
It’s more likely that existent health-care programs will expand to meet the demand — especially as the current economic recession makes every dollar count in many households.
For example, Oklahoman residents voted this past June to expand Medicaid, the first measure of its kind during this pandemic, creating a method other states can follow to further health-care enrollment.
Other states including Nebraska, Idaho, Kentucky, Maine, Montana, and Virginia had previously voted on similar measures, either within their state legislatures or via voter referendums, to expand Medicaid coverage, according to analysis by KFF. However, each of these measures were voted prior to the arrival of our current pandemic