How will COVID-19 shots be paid for after emergency ends?

The Biden administration and manufacturers are taking steps to maintain vaccine accessibility, particularly for the uninsured, as the shots transition toward commercialization.

But while Americans with insurance are still expected to be able to get vaccinated free of charge, questions remain over how those without coverage can obtain them and the ease of the overall process.

Moderna and Pfizer, the companies behind the two most commonly administered coronavirus vaccines in the U.S., are expecting the prices of their shots to increase by as much as four-fold but have stated that consumers should not expect to feel the impact themselves, regardless of insurance status.

As the official end of the emergency approaches next month, here are the emerging routes for the uninsured to maintain free access.

Federal avenues

The White House launched a new program this week specifically aimed at giving uninsured people access to both coronavirus vaccines and treatments, such as Paxlovid. The Biden administration characterized this new program as a public-private partnership.

According to the administration's announcement, the Department of Health and Human Services (HHS) plans to purchase vaccines at a discount and distribute them through state and local health departments.

The administration is investing $1.1 billion into this program, with plans to partner with pharmacies to carry it out.

"I do think this federal initiative to ensure that uninsured people have access to vaccines and, and treatments is actually really important," Jennifer Tolbert, Director of State Health Reform at the Kaiser Family Foundation, told The Hill.

According to Tolbert, this partnership should help uninsured individuals avoid hidden fees involved in receiving a vaccine.

The program is reminiscent of the government's test-to-treat initiative that sought to provide free rounds of Paxlovid to people soon after they tested positive for SARS-CoV-2. While many were able to take advantage of that push, others encountered roadblocks such as not living near participating locations or being unable to obtain positive diagnoses from health care providers due to being uninsured.

Without discounting the merits of the plan, Tolbert acknowledged that similar issues could occur, noting that individual pharmacies will still make their own decisions on whether to stock supplies of vaccines and treatments.

"Not everyone lives close enough to a community health center or even to a local health department to be able to access those sites," she said. "So, you know, expanding the locations where people can access treatments is really important."

Private industry

Both Pfizer and Moderna have said their patient assistance programs will ensure that all individuals will still be able to receive their vaccines free of charge.

Pfizer has also said it intends to continue donating doses to low- and middle-income countries.

Moderna, which had not brought a product to market before its COVID-19 vaccine, has said its program will become available following the end of the national public health emergency for COVID-19 on May 11.

Details on the programs have yet to be shared, but lawmakers have already expressed concerns over potentially complicated, involved processes that may discourage uninsured people from seeking immunizations.

During a recent hearing held by the Senate Committee on Health, Education, Labor and Pension, Sen. Bernie Sanders (I-Vt.) implored Moderna CEO Stéphane Bancel not to make the process too burdensome.

"Most patient assistance programs are poorly designed and extremely difficult, and I will be asking Mr. Bancel to make certain that this patient assistance program is simple, non-bureaucratic and in fact gets out to the people who need it," Sanders said.

Moderna did not immediately respond to inquiries from The Hill seeking details on its patient assistance program. When reached for comment, Pfizer referred back to previous statements it has made in which it committed to ensure vaccine access.

"The devil is in the details with programs like that," Tolbert said, pointing to paperwork and requests for documentation as common barriers for people seeking help from companies.

As was the case with accessing Paxlovid, drug companies may ask for documentation from a health care provider in order to provide assistance, which can be financially prohibitive for people without insurance.

At the moment, it appears that even the federal government is in the dark on how these companies plan to provide free vaccinations. When announcing its initiative to connect uninsured people with vaccines, HHS noted that "while COVID-19 vaccine manufacturers have committed to provide vaccines at no cost for the uninsured, thus far, the details of how this commitment would be fulfilled has not been fully clear."