How much commercial plan members could save if COVID-19 vaccine rates increase

If 80% of eligible Americans got fully vaccinated between now and March 31, 2023, the medical cost savings would come to $34 billion for those who receive the treatment through commercial insurance plans, according to a new Commonwealth Fund report.

If the uptake of bivalent and other COVID-19 vaccines matched the uptake for influenza vaccinations, the medical cost savings would come to $27 billion for individuals in commercial insurance plans. Those are just two of the highlights of the report which calculates the lives and money that could be saved (or lost) under three possible scenarios: If the rate of vaccine uptake continues as is, if the rate matches the 2020-2021 flu vaccine rate and if 80% of eligible American adults were fully vaccinated.

The paper updates one that researchers unveiled in July, except this one estimates what could be saved according to payer: Medicare, Medicaid, or commercial insurance companies. The Biden administration’s in the process of ending free distribution of COVID-19 vaccines and tests and shifting those costs to commercial insurance plans.

The crucial X factor remains vaccine uptake. Without a significant uptake of the new bivalent vaccine and vaccinations in general—no matter what stage an individual happens to be in their vaccination path—the healthcare industry could be in for a rough fall and winter. About 68% of Americans are fully vaccinated with a primary series, but only about 36% of adults 50 and older have gotten a booster shot.

Concern about a fall and winter surge of COVID-19 among some experts has been blunted a bit by the selling point deployed during the first vaccines, and subsequent booster shots: Maybe individuals will get sick, but the vaccines will prevent hospitalizations and death.

“If vaccination continued at its current pace through the end of March 2023, a potential winter surge in COVID-19 infections could result in a peak of around 16,000 hospitalizations and 1,200 deaths per day by March 2023,” the Commonwealth Fund report states.

The U.S. death toll from COVID-19 hovered around 1,200 a day around mid-March this year, but has fallen drastically since, according to data from the Johns Hopkins Coronavirus Resource Center. Yesterday, 43,303 new cases of COVID-19 were reported in the United States and 434 people died from the disease.

If 80% of eligible Americans got fully vaccinated between Oct. 1, 2022, to March 31, 2023, it could save $56.3 billion in direct medical costs. In addition, 90,000 lives would be saved, and more than 936,000 hospitalizations averted. If 80% of eligible Americans got the booster shot, the savings in direct medical costs for Medicare would be $13.5 billion, and for Medicaid it would be $4.5 billion.

“Under both scenarios modeled, we found an aggressive fall booster vaccination campaign could prevent COVID-19 deaths from exceeding 400 per day,” the report states.

Researchers concede that the bivalent vaccination might be a tough sell for a public that more and more wants the pandemic to be over with. For one thing, it’s so new that there’s no real-world data about how well it performs. Some question the data from which manufacturers used to create the bivalent vaccine as insufficient; being as it came from 10 mice.

The Commonwealth Fund report states: “In our analysis, we conservatively set the effectiveness of the bivalent vaccines against infection, symptomatic infection and severe disease caused by the BA.4 and BA.5 subvariants to those observed for a booster dose of the monovalent vaccines countering the BA.1 subvariant.”.

In calculating costs, they used the list price of $19.50 for the Pfizer-BioNTech vaccine and the Medicare cost for administering the dose at $40.

Authors also acknowledge COVID’s unpredictability, saying that “we did not consider the rise of yet another immune-evasive variant in our analysis, the estimated magnitude of the surge is primarily driven by waning immunity. With the rise of new Omicron subvariants, or an entirely new variant, the surge could be significantly larger, and our results may therefore underestimate the benefits of bivalent booster vaccination in terms of cases, hospitalizations, deaths, and medical costs averted.”