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[Maybell Hughs]

The federal government has spent more than $30 billion1 on COVID-19 vaccines, including the new bivalent boosters, incentivizing their development, guaranteeing a market, and ensuring that these vaccines would be provided free of charge to the U.S. population. However, last year, the Biden Administration announced that it no longer had funding, absent further Congressional action, to make additional purchases and it began preparing for the transition of COVID-19 vaccines to the commercial market. This means that manufacturers will be negotiating prices directly with insurers and purchasers, not just the federal government, and prices are expected to rise. Elsewhere, we have analyzed the implications of commercialization for access to and coverage of COVID-19 vaccines, finding that most, but not all, people will still have free access. Still, the cost of purchasing vaccines for the population is likely to rise on a per dose basis, though the extent to which it affects total health spending is dependent on vaccine uptake and any negotiated discounts, among other factors.

Here, we illustrate the potential total cost of Pfizer and Moderna COVID-19 vaccines, based on their publicly-announced expected prices, once they enter the U.S. commercial market. Specifically, we compare the average price paid by the federal government for the COVID-19 bivalent boosters to the estimated average commercial prices that have been suggested by manufacturers, and calculate an overall cost for purchasing vaccines for the adult population (ages 18 and older) across different scenarios of vaccine uptake (we only estimate costs for purchasing a single vaccine dose under different population uptake scenarios though it is possible that additional boosters will be needed on an annual or some other regular basis). While four COVID-19 vaccines have been authorized or approved for use in the United States, we focus our analysis only on Pfizer and Moderna vaccines, which account for almost all doses administered in the U.S. (97% as of March 22) and approximately 80% of all federal funding spent on COVID-19 vaccines.

The federal government has so far purchased 1.2 billion doses of Pfizer and Moderna COVID-19 vaccines combined, at a cost of $25.3 billion, or a weighted average purchase price of $20.69 per dose. In mid-2020, months before any COVID-19 vaccine was yet authorized or had even completed clinical trials, the federal government purchased an initial 200 million vaccine doses from Pfizer and Moderna (100 million each), at a price of $19.50 per dose and $15.25 per dose, respectively. This guaranteed an advance market for these vaccines, should they prove safe and effective and receive emergency use authorization (EUA) from the Food and Drug Administration (FDA), as each did in December 2020. In total, the federal government has made six different bulk purchases from Pfizer, totaling 655 million doses, and five bulk purchases from Moderna, totaling 566 million doses, for a total of 1.2 billion doses. Subsequent federal government purchases were made at a higher price per dose, with a weighted average across these purchases of $20.69. (See Figure 1 below and Tables in Appendix.)

The federal price paid per dose has generally increased over time, with the highest price paid for the most recent bivalent, or updated, boosters. The most expensive price per dose paid by the government was for the recent purchase of bivalent booster doses from each manufacturer, including 105 million doses at $30.48 per dose from Pfizer and 66 million doses at $26.36 per dose from Moderna (or a weighted average price per dose of $28.89). This represented a 56% increase in the price per dose for Pfizer, compared to the initial Pfizer purchase price, and a 73% increase for Moderna. In total, the U.S. has purchased 171 million doses of the bivalent booster at a cost of $4.9 billion.

While the commercial prices for COVID-19 vaccines are not yet known, both Pfizer and Moderna have signaled likely ranges that are three to four times greater than the pre-purchased federal price for the bivalent booster. In a recent investor call, Pfizer indicated that it expected a commercial price per dose for its vaccine to be between $110 and $130. Moderna has also suggested the same range. This range is 4 to almost 5 times greater than the weighted average price per dose paid by the federal government for Moderna and Pfizer bivalent doses ($28.90).

On a per-dose basis, the cost to continue to vaccinate adults in the U.S. against COVID-19 after federally purchased doses are depleted is likely to be significantly higher than the costs borne in the past by the federal government. Here, we find that the commercial price ranges announced by Moderna and Pfizer are four to almost five times greater than the pre-purchased federal price for the bivalent booster, resulting in comparatively high total costs even if, for example, only half the population were to get boosted. At the same time, it is important to note that even at higher spending levels driven by commercial pricing, COVID-19 vaccination is likely to be cost-effective compared to not vaccinating, given the effectiveness of these vaccines at preventing hospitalizations and deaths.

While most consumers with public and private insurance will be protected from having to pay directly for vaccine costs, those who are uninsured and underinsured may face cost barriers when the federally-purchased vaccine doses are depleted. In addition, as private payers take on more of the cost of vaccinations and boosters, this could have a small upward effect on health insurance premiums.

This includes vaccines that have been authorized for use in the United States (vaccines from Pfizer, Moderna, J&J, and Novavax) as well as others that either did not make it past the clinical trial phase or for which manufacturers have not sought authorization (vaccines from Merck/IAVI, Sanofi/GlaxoSmithKline and Astra-Zeneca).

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With all this hype, I decided to swing by my local game store (LGS) to pick up a booster box of draft boosters to sit on for a bit. I figured it was a novel set with a strong tie to a world-renowned property, so it was bound to be a success.

I arrived at the shop and asked how much the draft booster box of the new Lord of the Rings set cost. I was expecting the box to be marked up a little bit because I was purchasing from a small business, a brick-and-mortar store with overhead costs and all that. I was happy to support the shop, so I braced myself for something in the $120 range.

As such, it is my understanding that distributor pricing is in-line with sets like Modern Horizons and not like Core Set 2021, for example. A higher price at the distributor means game shops have to pay more for the product; a premium that they pass, in turn, to customers.

There are some noteworthy differences between Lord of the Rings and Dungeons and Dragons. While I have no hard data here, a quick Google search can provide some order of magnitude differences in the fanbase.

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Knowing the Difference between Car Seats and Booster Seats, especially how they apply to children with special needs, can go a long way. Children with special needs often have decreased core strength or abnormal muscle tone that affects the stability of their seated posture. This puts them at greater risk for injury in cars when challenged by quick direction changes, abrupt stops or accidents. Older children and young adults can benefit from booster car seats for much longer than their typically developing peers.

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