Interventions of Interest:

  • molnupiravir (Merck)
  • PF-07321332/ritonavir (Paxlovid™, Pfizer)
  • fluvoxamine (Investigator initiated)

We have deemed this a “special assessment” since this is an early snapshot of emerging agents in the COVID-19 pipeline. Each company has evolving timelines around data availability and potential approvals.

Independent appraisal committee voted 11-2 that the evidence is not adequate to demonstrate a net health benefit for molnupiravir over symptomatic care alone; Paxlovid and fluvoxamine received more favorable votes.

Through government price negotiation or generic pricing, economic modeling suggests all three treatments have prices well aligned with patient benefits, with all drugs also conveying important other potential benefits beyond direct health improvement.

Policy recommendations include a focus on transition to private market payment for these treatments, at which point manufacturers and payers should explore innovative reimbursement approaches such as subscription-based models or volume-based purchasing models in order to avoid restrictions on access through tight utilization management.

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Final Documents

ICER President Steven Pearson, MD, MSc stated:

“The evidence on outpatient treatments for COVID-19 must be viewed as highly sensitive to the evolving landscape of COVID-19 variants and vaccination status in the US. As indicated by the votes from the independent appraisal committee, the current evidence was judged more persuasive for Paxlovid and fluvoxamine than for molnupiravir, but clinical trials are ongoing for all three treatments.  

At their current negotiated price (molnupiravir, and Paxlovid) or their generic market price (fluvoxamine), these drugs appear to have prices reasonably aligned with patient benefits. One of the key lessons to be learned from the development of these drugs is that the federal government’s advance market commitment mechanism was effective in reducing the financial uncertainty that could have deterred manufacturers from bringing a drug to market, and ultimately resulted in multiple drugs becoming available in a relatively short time at prices that were aligned with clinical benefit.  That experience has many lessons for the future of US policy in preparing for future pandemics.”