COVID-19 Therapeutics Transition to Commercial Market, and UPDATE on COVID-19 Vaccine Coverage

Nov 17, 2023

In a letter released October 27, 2023, the U.S. Department of Health and Human Services (HHS) announced the plan to transition two COVID-19 oral therapeutics from government supplied to the commercial market. The transition process started on November 1, 2023, for Paxlovid manufactured by Pfizer and Lagevrio, manufactured by Merck.   

Providers are encouraged to utilize therapeutics distributed by the United States Government (USG) until such a time as those therapeutics are depleted or expired. The USG stopped accepting orders for Lagevrio after November 10, 2023. USG will continue to accept orders for Paxlovid through December 15, 2023.    

Additionally, the Maine Center for Disease Control and Prevention (CDC) reports that < 5% of Maine children aged 18 and younger are vaccinated with the updated COVID-19 formulation. Pharmacists who meet the conditions listed in the HHS COVID-19 Prep Act and who are not enrolled in the Vaccines for Children (VFC) program may submit for reimbursement for both the vaccine and its administration when they provide the vaccine to a MaineCare member aged 3 to 18 years old. This guidance applies only to qualified pharmacies; all other providers must be enrolled in and obtain the COVID-19 vaccine from the VFC program. This guidance also applies only to the COVID-19 vaccine. MaineCare encourages pharmacies to enroll in the VFC program to obtain COVID-19 and seasonal influenza vaccines at no cost by contacting the Maine Immunization Program at ImmunizeMe.dhhs@maine.gov.    

MaineCare will continue to provide full coverage, without cost sharing, through September 30, 2024, for COVID-19 therapeutics, vaccines, and vaccine administration as required by the American Rescue Plan Act (ARPA) of 2021. The ARPA requirement applies only to those persons with current MaineCare coverage. Anyone who is uninsured or who does not have full MaineCare coverage may have access to free or reduced cost therapeutics through patient assistance programs administered by the manufacturers and vaccines through the Bridge Access Program administered by the CDC.    

Providers may visit the Maine CDC COVID-19: Healthcare Providers Disease Surveillance website for up-to-date information on the use of COVID-19 therapeutics.    

If you have questions about the administration of, or reimbursement for COVID-19 therapeutics and vaccines, please contact your Provider Relations Specialist.