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A pharmacist delivers a COVID-19 booster dose at a CVS store in Chicago in October.

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The U.S. will stop buying Covid vaccines at discounted prices nationwide and will shift vaccine distribution to the private market as early as early fall, shifting the cost to U.S. insurers and uninsured Americans who will have access to the free vaccines could lose.

dr Ashish Jha, the White House Covid response coordinator, said in an interview with the UCSF Department of Medicine on Thursday that the move to a private market will occur in the summer or early fall, although no specific date has been set.

A senior official with the Department of Health and Human Services told CNBC the fall is a natural time to move to a private market, especially when the Food and Drug Administration selects a new Covid strain for the vaccines and asks manufacturers to provide updated shots to create in advance the respiratory virus season.

For the past two years, the US has bought vaccines directly from Pfizer And Modern at an average price of about $21 per dose, according to the Kaiser Family Foundation.

The federal government has obliged pharmacies, medical practices and hospitals to make these vaccinations available free of charge to everyone regardless of insurance status.

If you have health insurance

When the federal Covid immunization program ends, shots will remain free for people who have health insurance due to Affordable Care Act requirements.

But uninsured adults may have to pay for their vaccinations, if Pfizer And Modern Start selling the shots in the private market and the current federal supply will run out. There is a federal program to provide free vaccines to children whose families or caregivers cannot afford the vaccines.

Jha said Tuesday the proposed move was not tied to the end of the Covid public health emergency in May.

“The end of PHE does NOT mean people will suddenly be unable to get the vaccines and treatments they need,” Jha wrote in a Twitter thread on Tuesday.

When the federal government stops buying vaccines at a nationwide discount, individual health care providers will buy the syringes from the vaccine manufacturers at a higher price.

Moderna CEO Stephane Bancel told CNBC last month that the company is preparing to start selling the vaccines in the private market as early as this fall. Albert Bourla, Pfizer CEO, told investors during this week’s earnings call that he was preparing for the vaccines to hit the market in the second half of the year.

Pfizer and Moderna have said they are considering raising the price of the vaccines to around $110 to $130 per dose once the US government exits the vaccine program.

If you are not insured

“If you don’t have insurance, you may have to face the full cost,” said Cynthia Cox, Affordable Care Act expert at the Kaiser Family Foundation.

But the US still has a sizeable supply of free vaccines left. The Biden administration ordered 171 million Omicron boosters last year. About 51 million booster shots have been given to date, according to the Centers for Disease Control and Prevention.

The uninsured will continue to have access to those 120 million doses for free, but it’s unclear how long the supply will last.

“With the supply that we have of vaccines and antivirals, we don’t think we will be in a state of precipitous transition to drop this onto market partners,” the HHS official said.

Although vaccine makers are preparing to sell shots in the private market later this year, it’s possible the federal stockpile of free shots could last longer because uptake of booster shots has been low, Cox said.

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“Anyone in the United States, regardless of citizenship status or insurance status, can get a free vaccine while this federal supply lasts,” Cox said.

Sen. Bernie Sanders, I-Vt., slammed the vaccine price hike in a letter to Moderna’s CEO last month. Sanders, chair of the Senate Health Committee, said the rate hike would cost taxpayers billions because it impacts Medicaid and Medicare budgets.

“Perhaps most importantly, quadrupling prices will make the vaccine inaccessible to millions of uninsured and underinsured Americans who cannot afford it,” Sanders said. “How many of these Americans will die from Covid-19 because of limited access to these life-saving vaccines?”

Jha said this week that the Biden administration is committed to helping the uninsured access Covid shots and treatments.

“We are creating a whole series of separate efforts for the uninsured because, of course, by definition, the uninsured cannot get free vaccines and treatments under the regular insurance system,” Jha said Thursday. “We’re working on a plan for that.”

The HHS official said one tool the federal government plans to use is a program called Section 317, which provides funds for free procurement and administration of vaccines to uninsured adults.

ACA Requirements

But for the overwhelming majority of people with private insurance, the Affordable Care Act will cover the cost of the vaccines. Under the ACA, private health insurance is required to cover all CDC-recommended vaccinations at no cost to the consumer.

Medicare would cover the vaccinations for seniors who are most vulnerable to the virus, and those on lower incomes could get the vaccine through Medicaid.

There may be a small number of older, pre-ACA private health insurance plans that don’t need to cover Covid vaccines, Cox said. The HHS official said most of those plans would likely pay for the recordings.

Additionally, some short-term insurance policies might not pay for the vaccines, Cox said. These plans were expanded during the Trump administration and do not have to comply with the ACA.

The ACA also allows private insurance companies to limit vaccine coverage to providers on the network, Cox said. People who have become accustomed to getting vaccinated at any pharmacy during the pandemic may need to go to a specific drugstore to get a free shot in the future, she said.

Consumers could also see their health insurance premiums rise if Pfizer and Moderna raise the price of shots, Cox said.

Paxlovid may not be free

Depending on their insurance policy, some patients will probably also have to pay for Pfizer’s antiviral pill Paxlovid in the future. Unlike preventative services like vaccinations, the ACA does not require insurance to cover treatments.

Bourla told market analysts this week that Pfizer expects to start selling Paxlovid through the private market at commercial prices in the second half of 2023.

Pfizer hasn’t disclosed how much the antiviral will cost once it goes on sale. The federal government pays about $530 for a five-day treatment course. It’s unclear how much patients will have to pay out of pocket and how much of the price insurance will cover.

Dawn O’Connell, who heads the US federal agency responsible for stockpiling, said last August that the Department of Health and Human Services expects Paxlovid to be phased out by mid-2023.

Jha said Tuesday there are still millions of doses of Paxlovid and Omicron boosters in US supplies. “They will continue to be freely available to all Americans who need them,” Jha said of the remaining federal stockpile.

On December 30, leaders of the House and Senate Armed Services Committees announced the selection of former Google CEO Eric Schmidt and 11 others to serve on a new federal commission on biotechnology.

The National Security Commission on Emerging Biotechnology, tasked with scrutinizing the biotech industry and proposing investments that would benefit U.S. security, is expected to have a prominent voice on policy and federal spending in the cutting-edge industry.

However, the appointment does not require commissioners to divest their own personal biotech investments — even as they help shape U.S. policy by overseeing the industry. Schmidt has interests in several biotech companies through a venture capital firm called First Spark Ventures, which positions him to potentially profit if those companies are the beneficiaries of a new wave of federal biotech spending.

A person familiar with Schmidt’s thinking, who asked not to be named, told CNBC on Jan. 19 that he is not involved in selecting or overseeing federal investments in the sector and that he is not involved in decision-making about First Participating is Spark’s investment. The person also said they would comply with all disclosure rules.

Then, on Jan. 25, after a series of emails and conversations with CNBC about the possible conflict of interest, the person said Schmidt would donate 100 percent of the “net profits” from his investment in First Spark to charity. The person did not say when Schmidt made the decision to donate profits, adding that he has not yet named recipient charities.

Due to the nature of venture capital investments, it can take years for a company to be sold or taken public.

“This is a potential horror show,” Walter Shaub, the former director of the US Office of Government Ethics, said of the new commission. “Congress established this commission without proper safeguards against conflicts of interest.”

Shaub, an attorney who is now a senior ethics fellow with the nonpartisan nonprofit Project on Government Oversight, said members of the commission are exempt from criminal conflict of interest laws that could otherwise require them to self-retire or divest certain holdings because they were established by Congress and not the Executive Branch.

“These are individuals who will help shape federal policy at the intersection of biotechnology and national security, and will be legal for them to make recommendations that benefit their own personal financial interests,” Shaub said. “Because much of the work could be classified, the public may not have a way to assess how their financial interests affect their recommendations.”

A spokesman for the Senate Armed Services Committee, which will oversee the commission, said Schmidt and other members were selected by bipartisan leaders in the House and Senate and are expected to abide by government ethics rules.

“Every member of this commission must comply with all government ethics guidelines,” the spokesman said. “The Commission itself is designed to prevent undue influence, and Congress will closely monitor the work of the Commission.”

The new chairman of the commission, Dr. Jason Kelly, has no plans to step down as CEO of Boston-based biotech company Ginkgo Bioworks, which specializes in genetic engineering.

“Jason serves this commission in his personal capacity,” said Joseph Fridman, an executive at Ginkgo Bioworks. He didn’t elaborate on whether Kelly planned to divest potential stakes in the company as well. “I would also like to note that at Ginkgo in general, we take regular action to maintain our position as a trusted partner of the US government.”

Schmidt’s decision to donate his winnings “reaffirms that he’s volunteering for these roles for the right reasons,” said the person familiar with his mindset. “The main purpose is philanthropy,” the person said.

But Shaub said if Schmidt donated First Spark’s net profits to charity, it wouldn’t go far enough to address the issue. “To say he will donate all profits doesn’t change anything,” he said. “Either you have a financial interest in your government work or you don’t.”

The Pentagon is already heavily invested in the biotechnology sector. In September, for example, the White House announced that the Department of Defense will invest $1 billion over five years in bioindustrial domestic manufacturing infrastructure to help develop the US manufacturing base. The new federal commission is likely to have a say in how such investments are steered during its two-year existence.

It is not the first time that Schmidt has served on an influential Washington commission. In October, CNBC reported that Schmidt and his affiliates made more than 50 investments in artificial intelligence companies while he chaired a federal commission on AI from 2018 to 2021. There was no indication that Schmidt violated ethical rules or did anything illegal while leading the commission. And CNBC is not aware of any instances where Schmidt has abused his position on the previous commission for personal financial gain.

Still, at the time, Shaub called Schmidt’s AI arrangement “absolutely a conflict of interest” and said it was “not the right thing to do.”

Schmidt’s biotech investments are relatively new. Schmidt, who serves as a strategic advisor and non-executive partner, co-founded First Spark in 2021. The company’s investments are heavily focused in the biotech sector: in leading-edge companies like Walking Fish Technologies, which focuses on cell engineering; Vitara Biomedical, a neonatal care company; and Valitor, which specializes in protein-based drug therapies. Representatives from the three companies did not respond to requests for comment.

CNBC tried to reach First Spark officials via LinkedIn for comment, but received no response. The law firm’s website does not provide a phone number or email address.

CNBC attempted to reach out to the other members of the commission to determine how they would manage potential conflicts of interest. A spokesman for Rep. Ro Khanna, who was appointed to the commission, said the congressman does not own individual shares and his wife’s assets are held in a diversified trust managed by an outside financial advisor. “Qualified diversified trusts eliminate conflict and are therefore an appropriate vehicle to protect against potential conflict,” Khanna’s spokesman said.

Dawn Meyerriecks, the former CIA associate director for science and technology who will serve on the commission, told CNBC she has no personal investments in the biotech space.

“As you know, the commission is not fully established,” she said in a message via LinkedIn. “All Commissioners will submit all disclosure forms required to serve on the Commission and will work with the Government Ethics Adviser to consider any potential conflicts based on the expected work of the Commission.”

Mifepristone (Mifeprex) and misoprostol, the two drugs used in a medical abortion, are seen June 17, 2022 at the Women’s Reproductive Clinic in Santa Teresa, New Mexico, which provides legal medical abortion services.

Robyn Beck | AFP | Getty Images

Republican attorneys general in 20 states warned CV And Walgreens this week against the shipping of abortion pills in their jurisdictions, suggesting they would take legal action.

“We emphasize that it is our responsibility as attorneys general to obey the law and protect the health, safety and welfare of women and unborn children in our states,” the attorneys general said in letters to the country’s two largest drugstore chains Wednesday.

“Part of that responsibility is making sure businesses like yours are fully informed of the law so our citizens are not harmed,” the attorney general warned.

The Food and Drug Administration approved mifepristone as a safe and effective way to terminate pregnancy more than 20 years ago. The FDA says scientific and real-world evidence shows the pill is safer than surgical abortion and childbirth.

The pharmacies announced last month that they are seeking approval from the FDA to dispense the prescription pill in states where it’s legal.

The CVS and Walgreens decision comes after the FDA recently changed its rules to allow retail pharmacies to first-time dispense the pill as long as the prescription is from a certified healthcare provider.

“We are not currently selling mifepristone,” said Walgreens spokesman Fraser Engerman. “We intend to become a certified dispensary under the program, but understand that we may not be able to dispense mifepristone at all locations if we are certified under the program.”

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The pill mifepristone has become a central issue in the fight for abortion after the Supreme Court ruled last June that Roe v. Wade, which had protected access to the process as a constitutional right for 50 years.

Since the Supreme Court ruling, a dozen states have banned abortion outright. Other states have restrictions on mifepristone that conflict with FDA regulations for the drug.

The Biden administration issued a legal opinion last month arguing that the Postal Service can ship the pill to states where it is banned if the sender has no intention of breaking the law.

The Justice Department argued that even in states with strict abortion restrictions, there are exceptions where mifepristone would be legal. The DOJ’s statement came in response to a request from the USPS asking how it should deal with an 1873 statute called the Comstock Act, which bans items used to terminate a pregnancy from being shipped in the mail.

But attorneys general dismissed the Justice Department’s opinion as “bizarre” and said they expected courts to uphold their view that mifepristone cannot be mailed in their states.

There are several pending court cases regarding the FDA’s approval of mifepristone. GenBioPro, one of the pill’s makers, has sued to overturn West Virginia’s ban on abortion, arguing that FDA approval of drugs preempts state law.

Anti-abortion advocates have sued the FDA in a Texas federal court to remove mifepristone entirely from the US market. The FDA has called the lawsuit “extraordinary and unprecedented” and warned that a decision in favor of the physicians would compromise their licensing powers.

The letters to CVS and Walgreens were received from the Attorneys General of Missouri, Alabama, Alaska, Arkansas, Florida, Georgia, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Montana, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah and West Virginia.