US to shift from pandemic to endemic Covid-19 response

After three-plus years of living under a Covid-19 state of emergency, the US will enter its post-pandemic era later this spring.

The Biden administration plans to let the Covid national and public health emergencies enacted in the early days of the pandemic expire on May 11, along with some Covid-era rules and access to free testing, vaccines, and treatments.

The federal government’s transition to a more endemic response to Covid marks the symbolic end to the pandemic, which has killed more than 1.1 million people living in the US. But public health experts cautioned that that doesn’t mean Covid is no longer a threat.

“Covid is not over,” Leana Wen, a research professor of health policy and management at George Washington University, told Healthcare Brew. “Covid is now going to be treated similar to the flu, RSV, HIV, cancer, or other diseases, such that the reimbursement is going to be through insurance for treatment and testing.”

Wen, a practicing emergency medicine doctor, added that the end of the public health emergency designation—and the flexibilities granted to providers, hospitals, and insurers under it—could spark new efforts to improve the US healthcare system.

“There are innovations that have occurred as a result of the flexibilities given during Covid that should continue,” she said, pointing to advances in telemedicine as just one example. “But at the same time, there are also many flaws in our healthcare system that existed before Covid and [those] need to be addressed separately from the pandemic.”

Here’s what you need to know about the upcoming post-pandemic era.

Vaccines, testing, and treatments

Adults and children with Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) coverage will still have much access to Covid vaccines, testing, and treatments without cost sharing after the public health emergency ends, according to the Centers for Medicare and Medicaid Services (CMS). But Medicaid and CHIP enrollees could see changes in this coverage after the requirement ends on Sept. 30, 2024, due to varying state policies.

Uninsured individuals living in states that extended Medicaid coverage during the pandemic will be unable to access vaccines, treatment, or testing without cost sharing when the emergency ends, according to a CMS fact sheet. (Some people who received Medicaid during the pandemic may have lost coverage when states resumed redeterminations on April 1—something the federal government had barred since March 2020.)

Most people with private health insurance, meanwhile, should be able to access Covid vaccines from in-network providers without cost sharing, CMS noted. But mandatory coverage for over-the-counter and lab-based Covid PCR and antigen tests will end. The expiration of the public health emergency will not change how treatments are covered, and any existing cost sharing and deductibles will still take effect.

Moderna officials announced in February that the company will continue providing its Covid vaccine at “no cost” to insured people, regardless of whether they get inoculated at a doctor’s office or a local pharmacy. The drugmaker will also provide its shots to uninsured or underinsured individuals through its patient assistance program once the public health emergency ends.

But the cost for updated versions of that Covid shot (which will protect against new variants) are expected to rise to about $130 per dose, Moderna President Stephen Hoge told Reuters.

Pfizer executives, meanwhile, said last fall that they also expected the price of Pfizer’s Covid vaccine to rise to $110 to $130 per dose after the federal government’s purchase program ends.

Telehealth access

The pandemic ushered in new investments and interest in telehealth, as social distancing and fears of viral transmission forced many providers to take their services virtual. In response, the federal government and many states enacted policies to ease the transition to online care.

Some of those telehealth flexibilities are expected to remain in place, even after the emergency ends.

Provisions included in federal spending legislation passed at the end of 2022 will continue Medicare telehealth flexibilities relating to expanded services for rural health clinics, behavioral and mental health, and telehealth access options through December 2024, according to the Department of Health and Human Services. (Flexibilities available for Medicaid and CHIP recipients via state plan amendments will also continue.)

Temporary changes that allowed telehealth to be provided as an “excepted benefit” and let Medicare-covered providers use any non-public facing application (like FaceTime) to treat patients without fear of federal penalties, however, will end when the public health emergency designation expires.