The rollout of a vaccine for SARS-CoV-2, the virus that causes
COVID-19, is an unprecedented logistical challenge. So will be deciding who
gets it: experts say that the initial vaccine supply will not be large enough
to dose everyone who wants it — and payers and PBMs will have a large role to
play in distributing the medicine to the right people quickly.
David Simchi-Levi, Ph.D., a systems engineer who studies
manufacturing and supply chain at MIT, says that it's inevitable that vaccine
supply will not meet demand when it is available. "The question will be,
who gets it?" he says.
Mike Schneider, a principal at Avalere Health and a former
executive at CVS Health Corp.'s Caremark PBM, says that given the likely
scarcity of the vaccine, areas hardest hit by COVID-19 should be the focus of
the initial supply.
"I think the payers will probably try to stay out of the
way as much as possible, and let local laws determine who can get a vaccine and
probably local health departments determine who can get the vaccine before
others," Schneider says. He adds that payers should also use prior authorization
matched to FDA guidance to ensure the right people are dosed.
When a vaccine is available, Schneider expects retail pharmacies
to play a large role in delivery. He cites retail pharmacy chains' rollout of
drive-through SARS-CoV-2 testing and the annual ritual of getting a flu shot
from a pharmacist as examples of what delivering the coronavirus vaccine could
look like. Along the same lines, he expects primary care practitioners to
perform some inoculations.
Even a well-managed rollout will only be a first step.
Manufacturing and supply chain concerns will dictate the supply of vaccines
available in the U.S. going forward. So will trade, as most medicines are
manufactured in China and India. Those countries will certainly want to care
for their own citizens as soon as possible, which could delay the release of
vaccine here.
Given all that uncertainty, Schneider expects that a SARS-CoV-2
vaccine could be a perennial component of formularies, along the lines of the
flu vaccine. Schneider expects that receiving the coronavirus vaccine will be a
routine preventive treatment that costs patients little to nothing.
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