April 19, 2023 - Thanks to the Biden-Harris Administration’s whole-of-government approach to combatting COVID-19, we are now in a better place in our response than at any point of the pandemic. One of the critical components of our response has been ensuring all Americans have easy access to COVID-19 vaccines free of charge. Over the last two years, the Biden-Harris Administration has effectively implemented the largest adult vaccination program in U.S. history, with nearly 700 million doses of COVID-19 vaccines given to 270 million Americans.

Today, HHS is announcing the ‘HHS Bridge Access Program For COVID-19 Vaccines and Treatments Program’(“Program”) to maintain broad access to COVID-19 vaccines for millions of uninsured Americans. The program will create a unique $1.1 billion public-private partnership to help maintain uninsured individuals’ access to COVID-19 care at their local pharmacies, through existing public health infrastructure, and at their local health centers.

While fighting COVID-19 remains a key public health priority for the Administration, ensuring that all Americans have continued, easy access to COVID-19 vaccinations and treatments, regardless of insurance status, is critical to that goal. Partners across the United States government (USG) have been developing commercialization transition plans to ensure a smooth transition for the provision of COVID-19 vaccines and treatments from the purchase and distribution by the USG to traditional health care pathways.

When that transition occurs, most Americans should continue to pay nothing out-of-pocket for COVID-19 vaccines. For COVID-19 treatments such as Paxlovid and Lagevrio, out-of-pocket expenses for certain treatments may change after these products move to traditional health care models, depending on a person’s health care coverage. These expenses will be similar to costs one may incur for other drugs and treatments through traditional coverage.

In line with the Administration’s commitment to prioritize equity throughout the COVID-19 response, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra tasked HHS with developing a plan to promote access to COVID-19 vaccines and treatments for uninsured Americans during the continued transition of these products to traditional health care availability. This plan is designed to make sure that people can get the vaccines and treatments they need even if they do not have health insurance coverage.

‘HHS Bridge Access Program For COVID-19 Vaccines and Treatments’:

The program has two major components:

First, provide support for the existing public sector vaccine safety net, which is implemented through local health departments (LHDs) and Health Resources and Services Administration (HRSA) supported health centers.

• This combination of partners has historically been a key source of care for people without health insurance and has been at the forefront of this Administration’s response to COVID-19.
• Under the Program, the Centers for Disease Control and Prevention (CDC) will use its existing authority under Section 317 of the Public Health Service (PHS) Act to purchase and distribute COVID-19 vaccines and allocate them through its network of 64 state and local health department immunization awardees across the nation. These awardees will then distribute vaccines to LHDs and participating HRSA-supported health centers.
• Under the Program, HRSA will also provide support directly to its networks of health centers to support delivery of both vaccines and treatments.
• This structure builds on decades of experience and success in similar efforts through the Vaccines for Children program and Section 317-funded immunization programs.
• The Program is also consistent with the President’s Budgets for Fiscal Years (FYs) 2023 and 2024, which propose a permanent Vaccines for Adults (VFA) program, but this proposal has not yet been enacted into law. The proposed VFA program will provide permanent access to vaccines recommended for adults and would create a permanent solution to the existing gaps in access. However, since this program has yet to be enacted by Congress, a temporary solution is needed to prevent loss of access to COVID-19 vaccines and treatments for uninsured adults.
• As in those existing efforts, the Federal government will receive a discount for the purchase of these COVID-19 products, consistent with longstanding policy related to these and other similar Federal purchasing programs. 

Second, create a novel, funded partnership with pharmacy chains that will enable them to continue offering free COVID-19 vaccinations and treatments to the uninsured through their network or retail locations as has been done during the COVID-19 Public Health Emergency (PHE).

• Pharmacies have been a critical partner in the Administration’s response to COVID-19 and a critical access point for millions of Americans in receiving convenient and timely COVID-19 vaccines, treatments, and tests. This Program will also leverage the public commitments by drug manufacturers to provide vaccines and treatments, such as Paxlovid, free-of-charge for the uninsured. During the 2022-2023 season, available data show that more than two-thirds of adult COVID-19 vaccinations were administered at pharmacies.
• 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.
• In announcing this Program, HHS aims to support that commitment from manufacturers and ensure that the pharmacy setting remains a place of access for the uninsured.
• In building the Program, CDC will establish contracts with pharmacies to enable them to continue offering COVID-19 vaccines and designated treatments with no out-of-pocket costs to uninsured individuals, maintaining this critical access point for this population.
• Specifically, the Program will provide a per-dose payment to pharmacies in order to facilitate the administration of any COVID-19 vaccines and treatments at pharmacies that will be made available, relying on vaccine manufacturers' public and private commitments to provide COVID-19 vaccines at no cost for uninsured people.
• In return for alleviating manufacturers of this administrative burden and the expense of working directly with pharmacies, HHS expects that manufacturers ensure vaccines will be made readily available directly to pharmacies that participate in this effort and that manufacturers’ patient assistance programs will provide appropriate reimbursement or replacement for COVID-19 vaccines.
• Under these agreements, pharmacies will also be eligible for one-time base payments for each site targeting areas with low rates of access and low rates of vaccination. 
• As part of the Program, participating pharmacies will be expected to ensure appropriate oversight, including via patient attestations regarding lack of insurance coverage, and by providing CDC with periodic facility level data, at the direction of CDC.
• The pharmacies will also be expected to conduct outreach regarding the availability of the COVID-19 vaccine, including through community partnerships with a focus on underserved populations. 
• Additionally, these contracts will also allow uninsured individuals to receive access to certain COVID-19 treatments, including the drugs Paxlovid and Lagevrio, from participating pharmacies with no out-of-pocket costs.
• Over the next few months, HHS will establish new contractional relationships with pharmacies, so that this component of the program could be launched sometime this Fall. The goal is to include not only large pharmacy chains, but also smaller, local chains and independently owned pharmacies.

Together, these efforts will create a unique public-private partnership that will help maintain uninsured individuals’ access to COVID-19 care at their local pharmacies, at their local health centers, and through the public health infrastructure. To implement this commercialization transition plan for the uninsured, the Department has identified limited existing COVID-19 supplemental funds that can support this program through December 2024. In addition to filling a significant gap in access to COVID-19 vaccines and treatments for a vulnerable population, we hope this effort will also demonstrate to Congress the viability of approaches to extend access to other vaccines to uninsured adults.

As a more permanent measure, both the FY 2023 and FY 2024 President’s Budgets proposed the Vaccines for Adults program, which would be modeled after the successful Vaccines for Children program that already covers recommended immunizations for children, including vaccinations for COVID-19, with no cost-sharing. VFA would cover vaccination, including against COVID-19, at no cost for uninsured adults. To ensure long-term access to COVID-19 vaccines, HHS encourages Congress to authorize and fund the VFA.
Source: HHS