Pfizer sets Paxlovid price at nearly $1,400 per course

Pfizer has revealed what it will charge for a five-day course of its oral antiviral Paxlovid for COVID-19 when it starts to see it on the commercial market later this year.

The drugmaker has set a list price of $1,390 for the drug, far more than the approximately $529 per course that was charged to the US government under supply agreements during the pandemic, which allowed Paxlovid (nirmatrelvir/ritonavir) to be made available for free to US citizens from late 2021, when COVID-19 was at its peak.

Now, Pfizer is facing a very different environment for the drug, as well as its COVID-19 vaccine, as the market transitions to a post-pandemic commercial model driven by health insurers.

The price to insurers is expected to be less than the list price due to the US system of discounts and rebates, however, and the company has indicated it will work to make sure that patients will pay low or no out-of-pocket costs for the drug by subsidising co-pays until at least 2028.

The drug will also remain free of charge for patients who are in the federal Medicare and Medicaid insurance programmes until the end of next year.

Last year, the influential Institute for Clinical and Economic Review (ICER) in the US said that a fair price for Paxlovid for commercial insurer payment would be between $563 and $906 per course.

Last week, Pfizer announced staff cuts and a cost-reduction drive aimed at trimming around $3.5 billion off its operating expenses in the next two years as it manages that transition.

The company is predicting that sales of COVID-19 medicines will fall from more than $100 billion last year to between $58 billion and $61 billion in 2021, $9 billion lower than earlier forecasts, with $7 billion of that shortfall attributed to Paxlovid.

That contraction is expected to continue in 2024 unless a variant of COVID-19 emerges that prompts a surge in cases, hospitalisations, and deaths.

Paxlovid was granted emergency use authorisation (EUA) by the FDA in December 2021, becoming the first antiviral treatment for mild-to-moderate COVID-19 in adults who are at high risk for progression to severe COVID-19, including hospitalisation or death, that could be administered at home.

The US government bought around 24 million courses of the drug for use during the pandemic, but agreed the return of 7.9 million courses last week, which accounted for around $4.2 billion in the expected 2023 reduction, albeit in the form of a credit note against future purchases.

The US government will keep an ongoing stockpile of 1 million Paxlovid courses that will be refreshed as it expires, until 2028.