COVID-19 vaccine and drug pipeline

Executive summary

COVID-19, or the coronavirus disease, is an infectious disease caused by the virus SARS-CoV-2. Due to its contagious nature and risk of severe illness and death, efforts to contain the pandemic initially focused on the rapid development, approval and uptake of COVID-19 vaccines. However, as variants of the virus emerge, where vaccine efficacy or uptake is not as high, COVID-19 prevention and treatment options serve as another means to temper the effects of the pandemic.

To date, prevention and treatment options administered in hospital or in the community have been entirely funded and supplied by government bodies. In the future, private payers may play a role in providing coverage of these drugs should public funding priorities shift, particularly for outpatient community based treatments. This document summarizes which COVID-19 vaccines and drugs are available in Canada, as well as those currently under review by Health Canada.

COVID-19 Treatments

Approved hospital COVID-19 treatments

Research and development of COVID-19 treatments have been underway since the beginning of the pandemic. The earliest treatments approved by Health Canada were limited to injectable therapies administered at the hospital. A summary of the approved hospital based COVID-19 treatments are outlined below.

Approved outpatient community based COVID-19 treatments

Health Canada has now approved three COVID-19 treatments that can be administered in an outpatient setting. These treatments are indicated for mild to moderately infected individuals who are at high risk for severe outcomes, including hospitalization and death. The goal of these treatments is to help prevent hospitalizations so that hospital resources and capacity can be prioritized for those in need of urgent care.

Currently, all approved outpatient therapies are:

• indicated for individuals with lab-confirmed COVID-19 infection;
• to be given early in the course of illness, within five to seven days (dependent on therapy) of symptom onset; and
• for those at high risk of severe illness. The list of those who are considered high risk is extensive and includes:
  • unvaccinated or not fully vaccinated individuals who are:
    • advanced age;
    • pregnant; or
    • have a pre-existing health condition (including but not limited to diabetes, obesity, chronic obstructive pulmonary disease, asthma, and congestive heart failure).
  • immunocompromised individuals regardless of vaccination status.

While all therapies can be administered outside of a hospital, additional considerations may limit utilization in eligible patients. These considerations are outlined below for each treatment.

• Paxlovid
  • While convenient to administer as a combination of two oral antivirals, Paxlovid has numerous significant drug interactions that may restrict its use in eligible patients.
• Sotrovimab
  • A monoclonal antibody infused intravenously by trained health care individuals at a clinic, or by a mobile health care unit, can take up to three hours to administer.
• Remdesivir
  • An antiviral drug given intravenously by trained health care individuals at a clinic, or by a mobile health care unit. Each dose of Remdesivir takes up to 1.5 hours to administer and the treatment course is one dose a day for three days.

Despite the limitations of these approved treatments, the high infection rates of the COVID-19 variants still leave significant portions of the population eligible for outpatient treatment, which could lead to high utilization. In addition, these approved treatments for COVID-19 infection come with substantially higher price tags than other common infectious disease treatments; these therapies cost in excess of $530 USD per treatment course (see table below).

High utilization and expensive price points make coverage of COVID-19 outpatient treatments a significant financial commitment for any payer, public or private. To date, all outpatient treatment options have been publicly funded. Throughout the course of this pandemic, the federal government has made agreements to purchase limited quantities of COVID-19 drugs directly from manufacturers. So far, the Canadian government has agreed to purchase one million courses of Paxlovid, 30,000 courses of Sotrovimab and 150,000 vials of Remdesivir (for use in both hospital and outpatient settings), available to eligible Canadians free of charge.

Funding for COVID-19 treatments has not impacted private payers so far. Should public funding priorities shift and given the current private plan funding model for treatments for other infectious diseases, private plans may be called upon to cover these costly COVID-19 outpatient treatments in the future. This would represent a significant cost for private plans if high infection rates continue.

The table below outlines the three available outpatient treatments, with their pricing from other jurisdictions:

COVID-19 treatments under review

Health Canada is reviewing other treatments for active COVID-19 infection, ranging in price from $52 USD to $1,828 CAD per treatment course. As funding has not been announced for any of the following drugs, private payers may be responsible for coverage of these therapies if they are approved by Health Canada.

The following table outlines COVID-19 treatments currently under review by Health Canada. Where Canadian pricing is not available, pricing in other jurisdictions have been provided.

What's next

As COVID-19 vaccines and treatments have been publicly funded and supplied to date, the future cost impact of COVID-19 pharmaceuticals on private payers is currently unknown. Should government funding stop for these therapies, Alberta Blue Cross’s Drug Review Committee will review these drugs in a manner consistent with all other drug reviews prior to listing on our formularies.

Benefit plan management

Alberta Blue Cross’s benefit plan management team, comprised of industry experts, is dedicated to helping our customers make knowledgeable decisions on their benefit plans. Our in-house team closely monitors the drug landscape, including COVID-19 related treatments and vaccines, and its impact on drug benefit plans. We are committed to helping our customers navigate this changing landscape while always prioritizing the health of plan members and the sustainability of drug plans.