

And that means fewer people will get the potentially lifesaving treatments, experts said.
“I think the numbers will go way down,” said Jill Rosenthal, director of public health policy at the Center for American Progress, a left-leaning think tank. A bill for several hundred dollars or more would lead many people to decide the medication isn’t worth the price, she said.
In response to the unprecedented public health crisis caused by covid, the federal government spent billions of dollars on developing new vaccines and treatments, to swift success: Less than a year after the pandemic was declared, medical workers got their first vaccines. But as many people have refused the shots and stopped wearing masks, the virus still rages and mutates. In 2022 alone, 250,000 Americans have died from covid, more than from strokes or diabetes.
But soon the Department of Health and Human Services will stop supplying covid treatments, and pharmacies will purchase and bill for them the same way they do for antibiotic pills or asthma inhalers. Paxlovid is expected to hit the private market in mid-2023, according to HHS plans shared in an October meeting with state health officials and clinicians. Merck’s Lagevrio, a less-effective covid treatment pill, and AstraZeneca’s Evusheld, a preventive therapy for the immunocompromised, are on track to be commercialized sooner, sometime in the winter.
The U.S. government has so far purchased 20 million courses of Paxlovid, priced at about $530 each, a discount for buying in bulk that Pfizer CEO Albert Bourla called “really very attractive” to the federal government in a July earnings call. The drug will cost far more on the private market, although in a statement to KHN, Pfizer declined to share the planned price. The government will also stop paying for the company’s covid vaccine next year — those shots will quadruple in price, from the discount rate the government pays of $30 to about $120.
Bourla told investors in November that he expects the move will make Paxlovid and its covid vaccine “a multibillion-dollars franchise.”
Nearly 9 in 10 people dying from the virus now are 65 or older. Yet federal law restricts Medicare Part D — the prescription drug program that covers nearly 50 million seniors — from covering the covid treatment pills. The medications are meant for those most at risk of serious illness, including seniors.
Paxlovid and the other treatments are currently available under an emergency use authorization from the FDA, a fast-track review used in extraordinary situations. Although Pfizer applied for full approval in June, the process can take anywhere from several months to years. And Medicare Part D can’t cover any medications without that full stamp of approval.
Paying out-of-pocket would be “a substantial barrier” for seniors on Medicare — the very people who would benefit most from the drug, wrote federal health experts.
“From a public health perspective, and even from a health care capacity and cost perspective, it would just defy reason to not continue to make these drugs readily available,” said Dr. Larry Madoff, medical director of Massachusetts’ Bureau of Infectious Disease and Laboratory Sciences. He’s hopeful that the federal health agency will find a way to set aside unused doses for seniors and people without insurance.
In mid-November, the White House requested that Congress approve an additional $2.5 billion for covid therapeutics and vaccines to make sure people can afford the medications when they’re no longer free. But there’s little hope it will be approved — the Senate voted that same day to end the public health emergency and denied similar requests in recent months.
Many Americans have already faced hurdles just getting a prescription for covid treatment. Although the federal government doesn’t track who’s gotten the drug, a Centers for Disease Control and Prevention study using data from 30 medical centers found that Black and Hispanic patients with covid were much less likely to receive Paxlovid than white patients. (Hispanic people can be of any race or combination of races.) And when the government is no longer picking up the tab, experts predict that these gaps by race, income, and geography will widen.
People in Northeastern states used the drug far more often than those in the rest of the country, according to a KHN analysis of Paxlovid use in September and October. But it wasn’t because people in the region were getting sick from covid at much higher rates — instead, many of those states offered better access to health care to begin with and created special programs to get Paxlovid to their residents.
About 10 mostly Democratic states and several large counties in the Northeast and elsewhere created free “test-to-treat” programs that allow their residents to get an immediate doctor visit and prescription for treatment after testing positive for covid. In Massachusetts, more than 20,000 residents have used the state’s video and phone hotline, which is available seven days a week in 13 languages. Massachusetts, which has the highest insurance rate in the country and relatively low travel times to pharmacies, had the second-highest Paxlovid usage rate among states this fall.
States with higher covid death rates, like Florida and Kentucky, where residents must travel farther for health care and are more likely to be uninsured, used the drug less often. Without no-cost test-to-treat options, residents have struggled to get prescriptions even though the drug itself is still free.
“If you look at access to medications for people who are uninsured, I think that there’s no question that will widen those disparities,” Rosenthal said.
People who get insurance through their jobs could face high copays at the register, too, just as they do for insulin and other expensive or brand-name drugs.
Most private insurance companies will end up covering covid therapeutics to some extent, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. After all, the pills are cheaper than a hospital stay. But for most people who get insurance through their jobs, there are “really no rules at all,” she said. Some insurers could take months to add the drugs to their plans or decide not to pay for them.
And the additional cost means many people will go without the medication. “We know from lots of research that when people face cost sharing for these drugs that they need to take, they will often forgo or cut back,” Corlette said.
One group doesn’t need to worry about sticker shock. Medicaid, the public insurance program for low-income adults and children, will cover the treatments in full until at least early 2024.
HHS officials could set aside any leftover taxpayer-funded medication for people who can’t afford to pay the full cost, but they haven’t shared any concrete plans to do so. The government purchased 20 million courses of Paxlovid and 3 million of Lagevrio. Fewer than a third have been used, and usage has fallen in recent months, according to KHN’s analysis of the data from HHS.
Sixty percent of the government’s supply of Evusheld is also still available, although the covid prevention therapy is less effective against new strains of the virus. The health department in one state, New Mexico, has recommended against using it.
HHS did not make officials available for an interview or answer written questions about the commercialization plans.
The government created a potential workaround when they moved bebtelovimab, another covid treatment, to the private market this summer. It now retails for $2,100 per patient. The agency set aside the remaining 60,000 government-purchased doses that hospitals could use to treat uninsured patients in a convoluted dose-replacement process. But it’s hard to tell how well that setup would work for Paxlovid: Bebtelovimab was already much less popular, and the FDA halted its use on Nov. 30 because it’s less effective against current strains of the virus.
Federal officials and insurance companies would have good reason to make sure patients can continue to afford covid drugs: They’re far cheaper than if patients land in the emergency room.
“The medications are so worthwhile,” said Madoff, the Massachusetts health official. “They’re not expensive in the grand scheme of health care costs.”
While having a predisposition for Alzheimer's is not a diagnosis, it can help someone take the appropriate preventative measures. Hemsworth has said he is going to spend time focusing on stress and sleep management, nutrition and fitness.
According to the Alzheimer's Association, Alzheimer's is the most common cause of dementia, making up 60-80% of dementia cases. Dementia is not a normal part of aging, and is caused by damage to brain cells that can lead to memory problems, confusion and communication issues. "With dementia, it's a short term, memory-deficit, but usually long term is intact," said Andrea Shewalter, a nurse practitioner with OSF HealthCare Illinois Neurological Institute (INI). "People will forget what they ate for breakfast that day and they may forget having a specific conversation with a family member that morning or the day before, but they'll be able to tell you what they did 25 years ago and be able to reminisce with stories like that." Typically it's a loved one who notices the initial troubling signs of dementia such as memory loss, problem-solving difficulties or issues with daily tasks such as paying bills, taking medication or preparing meals, so it's the patients who are accompanied by family members to an appointment who are most likely exhibiting the greatest symptoms of dementia. Shewalter adds that anyone is a candidate for testing. And if you have a loved one who has been diagnosed with dementia you do not need to wait to develop symptoms to look into testing options for yourself. "When patients come in we refer them for a neuro psychological evaluation, where the psychologist reviews the 12 different domains of the brain through different systems and assessments," she says. "And they can come up with a potential diagnosis and are able to tell us what part of the brain is having a deficit or what deficit of the brain is occurring." But arriving at a dementia diagnosis isn't always easy. Physicians have to recognize a pattern of loss of skills and function and determine what a person is still able to do. And it usually takes more than one test to come up with the diagnosis. Tests include cognitive and neuropsychological tests, neurological evaluation, brain scans, lab tests and sometimes psychiatric evaluation. "I would refer anyone for neuropsychological testing, where they can help determine what areas of the brain are being affected," says Shewalter. "And then we usually send the patient for imaging to make sure that there's nothing from a pathological standpoint that's going on in the brain. Is there a brain tumor? Is there Lyme's disease? Is there some sort of disease that is affecting this? We can also look at the structures of the brain to be able to tell if there a lot of shrinkage for their age. Is the brain compensating due to the atrophy or the shrinkage of the brain?"1 | 2 | 3 | 4 | F | |
Urbana | 14 | 6 | 14 | 6 | 40 |
Danville | 3 | 5 | 4 | 13 | 25 |
DALLAS — Clearing sidewalks and driveways of snow may be essential to keep from being shut in, however, the American Heart Association urges caution when picking up that shovel or even starting the snowblower. Research shows that many people may face an increased risk of a heart attack or sudden cardiac arrest after shoveling heavy snow.
The American Heart Association’s 2020 scientific statement, Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective–An Update, notes snow shoveling among the physical activities that may place extra stress on the heart, especially among people who aren’t used to regular exercise. Numerous scientific research studies over the years have identified the dangers of shoveling snow for people with and without previously known heart disease.
The lead author of that scientific statement and long-time American Heart Association volunteer Barry Franklin, Ph.D., FAHA, is one of the leading experts on the science behind the cardiovascular risks of snow shoveling. He has authored a number of studies on the topic, estimating that hundreds of people die during or just after snow removal in the U.S. each year.
"Shoveling a little snow off your sidewalk may not seem like hard work. However, the strain of heavy snow shoveling may be as or even more demanding on the heart than taking a treadmill stress test, according to research we’ve conducted." said Franklin, a professor of internal medicine at Oakland University William Beaumont School of Medicine in Royal Oak, Michigan. "For example, after only two minutes of snow shoveling, study participants’ heart rates exceeded 85% of maximal heart rate, which is a level more commonly expected during intense aerobic exercise testing. The impact is hardest on those people who are least fit."
A study conducted in Canada a few years ago found that the chance of heart attack after a snowfall increased among men but not among women. The study found that, compared to no snowfall, a heavy snow – about 7-8 inches – was associated with 16% higher odds of men being admitted to the hospital with a heart attack, and a 34% increase in the chance of men dying from a heart attack.
"The impact of snow removal is especially concerning for people who already have cardiovascular risks like a sedentary lifestyle or obesity, being a current or former smoker, having diabetes, high cholesterol or high blood pressure, as well as people who have had a heart attack or stroke," he said. "People with these characteristics and those who have had bypass surgery or coronary angioplasty simply should not be shoveling snow."
Franklin said the most important thing is to be aware of the dangers, be prepared and take it easy, including taking short breaks. Even people who are relatively healthy should note that pushing the snow with a shovel is better physically than lifting and throwing it.
The American Heart Association urges everyone to learn the common signs of heart trouble and if you experience chest pain or pressure, lightheadedness or heart palpitations or irregular heart rhythms, stop the activity immediately. Call 9-1-1 if symptoms don’t subside shortly after you stop shoveling or snow blowing. If you see someone collapse while shoveling snow, call for help and start Hands-Only CPR if they are unresponsive with no pulse.
Learn more about cold weather and cardiovascular disease here.
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