Starting April 1, state employees in North Carolina will no longer have insurance coverage for costly weight-loss medications like Wegovy and Zepbound.In June 2021, the insurance plan for North Carolina state employees was paying for 2,800 people to take weight-loss drugs.Last year, it paid for nearly 25,000. Medications like Wegovy cost the North Carolina State Health Plan $100 million last year, rising seemingly out of nowhere to represent 10 percent of its spending on prescription drugs.“This is something we never anticipated,” said Dale Folwell, the state treasurer, whose office runs the health plan.Alarmed by the ballooning costs, the health plan’s governing board voted on Thursday to end all coverage of medications for weight loss, including Wegovy, which accounts for the vast majority of its spending on obesity drugs. The plan will continue covering versions of the drugs for people with diabetes.In the past few years, appetite-suppressing drugs have surged in popularity because they are extraordinarily effective in helping patients lose weight. Research suggests the medications may pay for themselves or even save money in the long run, by preventing heart attacks and strokes that lead to huge hospital bills.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

Many employers and government programs won’t cover costly obesity medications. A lawsuit is challenging one such policy.Jeannette Simonton was a textbook candidate for the obesity drug Wegovy when her doctor prescribed it to her in February.At 5 feet 2 inches and 228 pounds, she had a body mass index of nearly 42 — well above the cutoff U.S. regulators had approved for eligibility for the medication. She also had serious joint problems after decades of struggling with her weight.But her insurance refused to pay for the medication, citing a blanket ban on covering weight-loss drugs, according to a letter Ms. Simonton received in March from her benefits administrator.Now, Ms. Simonton is suing the Washington State agency that purchases health insurance for public employees like her. Her lawyers argue that the state’s health plans are discriminating against Ms. Simonton — and others who, like her, are seeking weight-loss drugs — in violation of state law, which recognizes obesity as a type of disability.Ms. Simonton’s case is a flashpoint in the conflict over whether health insurance should have to cover obesity drugs. The challenge for payers is that the medications would be hugely costly if they were broadly covered in the United States, where more than 100 million people are obese.The lawsuit is likely to be closely watched as a test of whether health plans can refuse to pay for obesity drugs. Ms. Simonton is being represented by a Seattle law firm, Sirianni Youtz Spoonemore Hamburger, that has a long track record of challenging health insurance restrictions, including those for costly hepatitis C cures.Wegovy and other appetite-suppressing drugs are in huge demand because they are stunningly effective in helping patients lose weight. But the scale of that demand would pose an unprecedented financial burden for the employers and government programs that shoulder most of the costs of prescription drugs. Wegovy, Novo Nordisk’s high-dose version of its popular drug Ozempic, has a sticker price of over $16,000 a year.More payers have recently begun covering the obesity medications, encouraged by research suggesting that the drugs may pay for themselves in the long run by improving patients’ health. But others say they simply cannot afford to cover the medications.Ms. Simonton, 57, a nurse who is well-versed on the health benefits of the drugs, said she saw the refusal to cover her Wegovy as shortsighted.“They’re being penny wise and pound foolish,” she said. “What will they be paying in 10, 15 years if I don’t continue to lose the weight?”The agency Ms. Simonton is suing, the Washington State Health Care Authority, declined to comment. Ms. Simonton gets her health insurance through the public hospital where she works. As part of her compensation, her hospital pays premiums to the state, which the Health Care Authority uses to pay for her health plan. The agency has authority over which drugs are covered.Wegovy is in a class of injectable drugs known as GLP-1s, named after the natural hormone whose effects they emulate. The drugs have been used for years to treat Type 2 diabetes but more recently have been recognized for their extraordinary power to slash body weight.Wegovy is in a class of injectable drugs that have been used for years to treat Type 2 diabetes but more recently have been recognized for their extraordinary power to slash body weight.Jim Vondruska/ReutersAbout 36 million people with Type 2 diabetes in the United States — as well as about 18 million who are obese but not diabetic — have access to GLP-1s through their health plans, according to analysts at the investment bank Jefferies. That is about 17 percent of the country’s insured people.Federal law prohibits Medicare from paying for drugs for weight loss, a ban that persists largely because of the staggering costs. If Congress were to overturn the ban, one projection from academic researchers estimates that two million Medicare beneficiaries — 10 percent of older people with obesity — would take Wegovy. Under that scenario, the government’s annual expenditure would be $27 billion, nearly a fifth of the yearly spending for Medicare’s Part D program covering prescription drugs taken at home.Employers and state health insurance programs for public employees face a similar dilemma. In Arkansas, where 40 percent of people on the plan for state employees have obesity, covering the drugs would cost $83 million annually. The Wisconsin program would have to come up with an additional $25 million annually.“Employers don’t suddenly have a new pot of money to pay for higher health insurance premiums,” said Dr. Steven Pearson, president of the Institute for Clinical and Economic Review, which assesses the value of medicines. “We’re talking about big changes to companies’ ability to provide other benefits, wage increases, new hires, and they may also have to turn that into higher premiums for their own employees.”Another worry for employers is that they may not actually reap the savings of investing in weight-loss medications. Averted heart attacks and avoided hospital stays made possible by the drugs may not manifest in savings until years down the line, when a patient has left that employer.But advocates for patients with obesity see stigma and bias at play when health plans view weight-loss treatment as akin to unnecessary vanity procedures.Ms. Simonton, who lives in Ellensburg, Wash., has had obesity for as long as she can remember. At one point in her 40s, she weighed 424 pounds. After she underwent an operation to reduce the size of her stomach, her weight fluctuated for years above 250 pounds.The weight has taken a toll. With osteoarthritis so bad that the bones in her knees were rubbing against one another, she has already had her right knee replaced and has surgery for her left scheduled for next month. “I wondered if I was going to have a nursing career left,” she said.Last year, she started taking Mounjaro, another powerful GLP-1 medication, with most of her costs covered by the drug’s manufacturer, Eli Lilly. When that assistance ran out, she paused treatment while her doctors helped her seek insurance coverage for the Novo Nordisk drug.In February, frustrated by the lack of progress, Ms. Simonton began paying out of pocket to obtain a version of the Novo Nordisk medication from a compounding pharmacy.Since she started taking GLP-1 drugs in September 2022, she has lost 76 pounds. She now weighs 191 pounds.“My life has changed, in an amazing way,” she said. “It’s the first time where I’m not constantly thinking about food.”But to cover the out-of-pocket costs — nearly $2,000 so far — Ms. Simonton and her husband have reduced their spending on groceries and cut their retirement savings.Ms. Simonton’s lawsuit, filed in state court in Washington last month, is seeking to force her health plan to pay for Wegovy going forward, as well as reimbursement from when she was denied coverage. Her lawyers are seeking class-action status on behalf of others like her who are insured through plans for public and school workers in Washington State.In 2019, Washington State’s Supreme Court ruled that obesity is “always” a protected disability under the state’s anti-discrimination law. Other courts outside the state have ruled that obesity is not usually protected.

Mallinckrodt Pharmaceuticals had promised $1.7 billion to governments, individuals and others harmed by the opioid crisis.A major opioid manufacturer that had promised to pay $1.7 billion as compensation over its role in the opioid crisis disclosed on Wednesday that it had reached an agreement with its creditors to reduce the settlement payments by $1 billion.The manufacturer, Mallinckrodt Pharmaceuticals, had originally agreed to pay the $1.7 billion over eight years to state and local governments, individuals and others that had sued the company for helping fuel the opioid crisis. The funds had been earmarked for addiction victims to rebuild their lives and for governments to pay for priorities like drugs to reverse opioid overdoses.In a regulatory filing on Wednesday, Mallinckrodt disclosed that it had reached a plan to file for bankruptcy for the second time in three years. The plan would cancel a majority of the $1.25 billion that the company still owes under the original settlement agreement, in exchange for a final payment of $250 million that would be made before the company enters its second bankruptcy.The plan to cancel a majority of the outstanding payments was devised with backing from hedge funds that would control the company under a second bankruptcy. The funds had lent money to Mallinckrodt and were in a position to force the company to prioritize paying back its lenders over compensating victims.The revised plan still requires bankruptcy court approval. The company’s chief executive, Siggi Olafsson, said in a news release that the company “remained committed to ensuring that we achieved a meaningful resolution” for the trust set up to disburse settlement payments to victims. Mallinckrodt did not immediately return a request for additional comment.The original settlement plan, finalized last year as Mallinckrodt exited its first bankruptcy, protected the company and its former executives from future liability related to its opioid sales.Mallinckrodt last year made its first and only payment, of $450 million, under the original settlement agreement. The company is late on a second payment, which was due in June.The revised plan was agreed to by a master trust that oversees the distribution of payments to subordinate trusts tasked with disbursing money to victims. Governments have begun receiving the initial funds. The money earmarked for individuals has not yet been disbursed but is expected to go out soon.Joseph Steinfeld, a lawyer representing about half of the approximately 40,000 individuals who had been promised payments as part of the settlement, said that the revised plan would reduce the amount going to that group by about $100 million.“What was promised was a significant amount to many of the victims that were counting on it,” Mr. Steinfeld said. “They’re losing about 70 percent of what they were promised.”Mallinckrodt is among a number of manufacturers, pharmacy chains and distributors that have agreed to large settlements with governments and other victims who accused them of seeding a public health disaster by pushing prescription opioids and downplaying their addiction risks.While Purdue Pharma has become a household name for its role in the opioid crisis, Mallinckrodt has been less recognized, even as its product known as Roxicodone became one of the widely misused legal painkillers. Documents that were made public through the company’s first bankruptcy filing showed how Mallinckrodt aggressively promoted its prescription painkillers as the opioid crisis took hold in communities around the country.

The drug, which will be sold as Qalsody by the pharmaceutical company Biogen, targets a genetic cause of a devastating neurological illness.The Food and Drug Administration on Tuesday authorized the first drug for a rare genetic form of the neurological disorder A.L.S., despite uncertainty about the treatment’s effectiveness.The decision reflects the agency’s push toward greater flexibility in approving treatments for patients with devastating illnesses and few, if any, options.Biogen, the pharmaceutical company bringing the drug to market, said it would price the drug “within a range comparable to other recently launched A.L.S. treatments.” An A.L.S. therapy approved last year was priced at $158,000 annually.The drug, which is known scientifically as tofersen and will be sold under the brand name Qalsody, targets a mutation in a gene known as SOD1 that is present in about 2 percent of the roughly 6,000 cases of A.L.S. diagnosed in the United States each year. Fewer than 500 people in the United States at any given time are expected to be eligible.The agency authorized the treatment via a policy that allows a drug to be fast-tracked onto the market under certain circumstances before there is conclusive proof that it works. Biogen will be required to provide confirmatory evidence, from ongoing clinical research, to keep the drug on the market.The decision marks the first conditional approval granted for a medication for A.L.S., or amyotrophic lateral sclerosis, which generally causes paralysis and death within a few years. Less than half of the patients eligible for Qalsody survive more than three years after their diagnosis.The approval is based on evidence that the drug can significantly reduce levels of a protein that has been linked to damage to nerve cells. Biogen has argued that these results are reasonably likely to help patients, even though the drug, in a clinical trial, did not significantly slow the progression of the disease, as measured by patients’ ability to speak, swallow and perform other activities of daily living.Despite the uncertainty about its benefit, Qalsody’s approval is widely seen as more justifiable than that of Aduhelm, another drug from Biogen that prompted an outcry when it was approved by the F.D.A. in 2021 to treat Alzheimer’s despite a lack of evidence that it worked.At a meeting last month, a panel of independent advisers to the F.D.A. unanimously recommended that the agency grant conditional approval of Qalsody, despite a majority of advisers concluding that there was not convincing evidence that it was effective.A.L.S. patients and advocacy groups mounted an impassioned campaign for the drug. F.D.A. officials last month wrote that their approach to evaluating such medications has been shaped by the agency’s “interactions with patients and their caregivers who describe their willingness to accept less certainty about effectiveness in return for earlier access to much-needed medicines.”Patients receive Qalsody as an injection into the spinal canal every few weeks. The drug was found to be generally safe, though a small number of patients developed inflammation of the spinal cord.Before Qalsody, there were only three approved A.L.S. medications in the United States, which have not significantly altered the course of the disease.

The company is the third of the three major insulin manufacturers that dominate the U.S. market to announce such a move this month.Facing pressure to follow a wave of industry price cuts, the drug maker Sanofi said on Thursday that it would reduce the sticker price of its most commonly used insulin by 78 percent.The company said it would also cap, at $35 per month, that product’s out-of-pocket costs for diabetes patients with private health plans.Sanofi’s moves, which will go into effect at the start of next year, follow similar announcements this month by the two other large insulin manufacturers, Eli Lilly and Novo Nordisk. Together, the three companies control about 90 percent of the insulin market in the United States.The price cuts are likely to reduce how often Americans with diabetes struggle to pay for insulin, which millions depend on to stay alive. A federal law that went into effect at the start of this year had already capped out-of-pocket costs for insulin at $35 per month for people covered by Medicare.President Biden and Democratic lawmakers have taken credit for the drug makers’ moves, but the companies were facing fewer financial incentives to keep prices high on their older insulin products. Their businesses have grown more reliant on newer drugs for diabetes and obesity. They were also facing looming penalties that would have forced them to pay Medicaid back for raising their prices faster than inflation.For years, Sanofi repeatedly increased the list price of its most frequently prescribed insulin, Lantus, which the Food and Drug Administration first approved in 2000. The company said it was bringing in less from its insulin products after discounts and rebates were accounted for, compared with a decade ago, and it has blamed insurers for not passing savings down to patients.Sanofi already had a program capping monthly insulin costs at $35 per patient for the uninsured. Previously, all commercially insured patients were eligible for a Sanofi co-pay assistance program that significantly limited costs for most of them, but a cap was not in place. Under Sanofi’s new policy, the cap will automatically go into effect at the pharmacy counter, making it easier for patients to take advantage of.

The company’s decision follows a similar move by its rival, Eli Lilly, this month.The drug company Novo Nordisk on Tuesday said it would reduce the sticker prices of several of its insulin products by up to 70 percent, reversing years of price increases in the face of mounting pressure.The company did not announce any changes to the out of pocket costs for patients with diabetes, but it said that its existing programs kept those costs as low as $25 per vial for many patients. Instead, the price cut will affect only the list price, which is the starting point for a series of negotiations and discounts that ultimately determine how much a drug costs.The decision by Novo Nordisk, one of the world’s largest insulin manufacturers, follows a similar move by its rival, Eli Lilly, this month. It comes after President Biden, lawmakers and patient advocates called on the company to reduce costs for patients. At the start of this year, a federally mandated cap went into effect, limiting out of pocket costs for insulin, to $35 per month, for older people covered by Medicare.Novo Nordisk said its price reductions would go into effect at the start of next year. The list price of a vial of rapid-acting NovoLog, one of the most widely used insulin products, will fall to $72, from $289. The new price was still about twice what it was when NovoLog was introduced in 2000.Novo Nordisk said its price cuts would also apply to NovoLog injection pens, long-acting Levemir, intermediate-acting Novolin and several generic insulins.Insulin, which millions of diabetes patients depend on to stay alive, has for years been a flash point as concern has mounted over high drug prices. Although manufacturers have long had programs designed to limit out of pocket costs, patients don’t always know about them and even when they do, they can have strict eligibility requirements and be onerous to navigate. Some patients, facing out of pocket costs of hundreds of dollars per month, have had to resort to rationing insulin.The effects of the manufacturers’ price cuts may be limited. There is often a wide gulf between an insulin product’s list price and the net price that the company charges insurers after accounting for discounts and rebates. Insulin manufacturers, which repeatedly increased their prices for years, have blamed pharmacy benefit managers, which act as middlemen to negotiate prices on behalf of health plans, for clawing back larger rebates.Sanofi, the third of the three manufacturers that dominate the insulin market in the United States, declined to comment on whether it would follow its rivals. Olivier Bogillot, a Sanofi executive, said in a statement that all commercially insured and uninsured patients were eligible for programs that would significantly limit their out of pocket costs.

Biogen said on Tuesday that it will replace its chief executive and effectively give up on marketing a high-profile Alzheimer’s drug that has been a commercial failure since its controversial approval nearly a year ago.Michel Vounatsos, who has led the drug maker for over five years and presided over the approval and launch of the drug, known as Aduhelm, will remain in his role until a successor is appointed, Biogen said.Biogen said it planned to “substantially eliminate” its spending on the drug after Medicare finalized a decision last month to sharply limit its coverage of Aduhelm.The Food and Drug Administration approved Aduhelm in June. It was the first new treatment for Alzheimer’s in nearly two decades. It had been widely expected to become a blockbuster drug within several years, generating billions of dollars annually for Biogen. But the approval was overshadowed by concern about the drug’s unproven benefits and serious safety risks, as well as about the process by which the F.D.A. had greenlighted it.Doctors, insurers and patients and their families have not embraced Aduhelm. On Tuesday, Biogen reported that the drug brought in just $2.8 million in revenue in the first three months of this year, after generating only $3 million in 2021. Biogen initially priced the drug at $56,000 per year for the average patient before halving the cost in response to weak early sales.Aduhelm had been expected to strain government health budgets. But Medicare decided to pay for the drug only for people who receive it as participants in a clinical trial. Last month, Biogen said it would withdraw its application to market the drug in the European Union after drug reviewers indicated that it was unlikely to win approval.

Just after 1 p.m. on Tuesday last week, my phone buzzed with a text message from my mother: “Well, came down with cold, aches, cough etc over wknd.” She had taken an at-home coronavirus test. It was positive.Having spent the past year writing about Covid-19 vaccines and treatments for The New York Times, I knew a lot about the options available to people like my mother. Yet I was about to go on a seven-hour odyssey that would show me there was a lot I didn’t grasp.My mother, Mary Ann Neilsen, is fully vaccinated, including a booster shot, which sharply reduced the odds that she would become seriously ill from the virus. But she has several risk factors that worried me. She’s 73. She has twice beaten breast cancer.Her age and cancer history made her eligible to receive the latest treatments that have been shown to stave off the worst outcomes from Covid. The trouble, as I knew from my reporting, was that these treatments — including monoclonal antibody infusions and antiviral pills — are hard to come by.Demand for the drugs is surging as the Omicron variant of the coronavirus infects record numbers of Americans. But supplies are scarce. The two most widely used antibody brands don’t appear to work against Omicron, and the antiviral pills are so new and were developed so quickly that not many have reached hospitals and pharmacies.I set out to track down one of two treatments: GlaxoSmithKline’s antibody infusion or Pfizer’s antiviral pills, known as Paxlovid. Both have been found to be safe and highly protective against severe Covid when given to high-risk patients within a few days of the onset of symptoms. Both are potent against Omicron.One of my first steps was to search online for lists of pharmacies and clinics near my mother’s home in Santa Barbara, Calif., that might have one of the drugs in stock. (I live in Washington State, so my quest was conducted, like so much else these days, remotely.)Some states, like Tennessee and Florida, have useful online tools for finding a facility with monoclonal antibodies in stock. But I couldn’t find one for California. I checked a federal database, which had only one listing within 25 miles of my mother.When I called that health system, I was told that it had run out.I also hunted for Paxlovid. From my reporting, I knew about a federal database of pharmacy chains, hospital systems and other providers that have placed orders for the pills. A Times colleague downloaded the data, as anyone can do, and sent it to me in a more easily searchable format.The list turned up only a few possibilities, mostly pharmacies, near my mother. I dialed the closest one, a CVS, but an employee informed me that the store had quickly run out of the first shipment of pills and didn’t know when more would come.After a few more calls, I found a Rite Aid, more than an hour’s drive from my mother’s apartment, that had Paxlovid in stock. The pharmacy warned me that the supply was going fast.Still, this was good news. I figured I had just surmounted the toughest obstacle, and only two hours had passed since my mother tested positive. Now I just needed to get her a prescription.Ms. Neilsen at her home in Santa Barbara, Calif.Alex Welsh for The New York TimesI had already asked my mother to call her doctor’s office and request a phone call with her physician so she could ask for a prescription for one of the treatments. She reported back to me that the receptionist had told her that they “don’t do” either the Glaxo or Pfizer treatments.That didn’t make sense to me: The Food and Drug Administration has authorized the drugs. Why wouldn’t doctors be prescribing them? Frustrated, I called her doctor’s office to get an explanation. (I did not identify myself as a Times reporter, in that phone call or the others I made that day, in part because I did not want to create the appearance of seeking preferential treatment.)The employee who answered the phone told me that the doctors there had yet to conduct their own medical review of Paxlovid and, as a matter of policy, could not yet prescribe it. Moreover, the employee told me, my mother would need an appointment to speak to a doctor, and there were no slots until a week later.I began hunting for another doctor who would promptly write a prescription.I tried scheduling visits with several telemedicine providers, including CVS and Teladoc, but I kept seeing a similarly worded notification on the intake forms: They were not writing prescriptions for Paxlovid or molnupiravir, a similar antiviral pill from Merck.(Later, I asked both companies about these policies. A CVS spokeswoman said providers were prescribing the antiviral pills to patients they saw in person at some stores but not via telemedicine. A Teladoc spokesman said the company believed at this point that “it’s most appropriate” for the antiviral pills to be prescribed in person.)I started calling urgent care clinics and health systems near my mother to see if they would write her a prescription. At one point, we even got her on a video call with a doctor at a nearby health system.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4Omicron in retreat.

The drug maker Biogen said on Wednesday that a panel of drug reviewers in the European Union had indicated that its new Alzheimer’s drug was unlikely to be approved there, the latest setback for a medication that has been mired in controversy since it was in approved in the United States in June.Biogen said a committee of experts that advises the European Medicines Agency had issued a “negative trend vote” — a preliminary signal that typically precedes a recommendation that the drug not be approved — on the company’s application for the drug, Aduhelm, this month. The panel will formalize its recommendation at a meeting next month.The company’s interim research chief, Dr. Priya Singhal, said Biogen was “disappointed” with the panel’s vote. Biogen said in a statement it would continue to work with European Union regulators “as it considers next steps” to try to get the drug approved in Europe.In the United States, the Food and Drug Administration approved the drug despite conflicting clinical trial results and the objections of its own independent advisers and many Alzheimer’s experts, who believed there was not enough evidence to show that Aduhelm is effective.In one study that yielded a positive result, a high dose of the drug only modestly slowed decline. Typically mild but potentially serious side effects like brain swelling or bleeding occurred in 40 percent of clinical trial participants.Biogen introduced the drug with a $56,000 annual price tag, on average, fueling expectations that it would strain government budgets within a few years. But the drug has had a stunningly slow start in its first few months of commercial availability. The company reported that the drug brought in just $1.9 million in revenue from the time it became available in the United States in June to the end of September.In the United States, the federal agency that administers Medicare is reviewing whether to standardize coverage of the drug nationwide, a step that could restrict which patients receive it. A draft decision is expected in January, with a final decision by April.The company announced on Monday that its research chief who had championed the internal effort to develop Aduhelm, Al Sandrock, would retire from the company at the end of the year.

Pfizer’s is the second pill to show effectiveness against Covid-19, and it is the first purpose-built to attack the virus that causes the disease.Pfizer announced on Friday that its pill to treat Covid-19 had been found in a key clinical trial to be highly effective at preventing severe illness among at-risk people who received the drug soon after they exhibited symptoms.The antiviral pill is the second of its kind to demonstrate efficacy against Covid. It appears to be more effective than a similar offering from Merck, which is awaiting federal authorization.Pfizer’s pill, which will be sold under the brand name Paxlovid, cut the risk of hospitalization or death by 89 percent when given within three days after the start of symptoms.Pfizer said an independent board of experts monitoring its clinical trial recommended that the study be stopped early because the drug’s benefit to patients had proved so convincing. The company said it planned to submit the data as soon as possible to the Food and Drug Administration to seek authorization for the pill to be used in the United States.“The results are really beyond our wildest dreams,” said Annaliesa Anderson, a Pfizer executive who led the drug’s development. She expressed hope that Paxlovid “can have a big impact on helping all our lives go back to normal again and seeing the end of the pandemic.”The treatment could become available in the next few months, though supplies are likely to be limited at first. The Pfizer and Merck pills are both geared toward patients regarded as high-risk, such as those above the age of 60 or with conditions like obesity that make them more susceptible to severe consequences from Covid.The arrival of a new class of easy-to-use pills that dramatically reduce hospitalizations could help bring the curtain down on the most severe phase of the pandemic, at least in wealthy countries where most adults have been vaccinated.Pfizer and Merck have said that they have already begun producing pills and plan to ramp up production over the next year.The U.S. government has been in negotiations with Pfizer for enough pills for 1.7 million courses of treatment, with an additional option for 3.3 million, according to a senior administration official. That is about the same quantity that the United States has ordered from Merck. The government expects to pay about $700 per treatment course for both drugs, the official said.A number of wealthy countries, including Britain and Australia, have also raced to lock up supplies of Pfizer’s drug.Pfizer said it planned to offer poorer countries the drug at discounted prices. The company has been in talks with a United Nations-backed nonprofit, the Medicines Patent Pool, to allow the pill to be made and sold inexpensively in such countries; Merck has already reached a similar deal.Donald Davis, one of the participants in the clinical trial of Pfizer’s antiviral pill.Michael Stravato for The New York TimesThe Pfizer and Merck pills, which can be dispensed at pharmacies and taken at home, are expected to reach many more people than monoclonal antibody treatments, which are typically given by intravenous infusion at a clinic. The treatment consists of 30 pills given over five days. That includes 10 pills of ritonavir, an old H.I.V. drug, which helps Pfizer’s drug remain active in the body longer. (Merck’s treatment course is 40 pills over five days.)The pills so far have mainly been tested in high-risk patients. But Pfizer is also running trials on low-risk patients and people in the same household as those infected with the virus.The efficacy results announced on Tuesday included data from more than 1,200 adults in the United States and overseas who received either Pfizer’s drug or a placebo pill after contracting Covid. The volunteers were enrolled between July and September, when the Delta variant was ripping across the globe. They were unvaccinated and had at least one characteristic that put them at greater risk of becoming severely ill from the virus, such as older age or having obesity or diabetes.Pfizer’s 89 percent efficacy figure came from the group of volunteers who started treatment within three days of developing symptoms. Including people who began treatment on the fourth or fifth day, the pill reduced the risk of hospitalization or death by 85 percent.By contrast, the Merck pill was about 50 percent effective when given within five days of the onset of symptoms, though the different designs and timing of the Pfizer and Merck trials make such comparisons imprecise. Monoclonal antibody treatments reduce hospitalizations and deaths by at least 70 percent in high-risk Covid patients, but those treatments are more expensive and more cumbersome to administer.Study volunteers who got the Pfizer pill reported mostly mild side effects at a slightly lower rate than those who received the placebo pill. That was a promising sign for the drug’s safety, indicating that Covid symptoms are probably more bothersome than any of the pill’s side effects.The origins of Pfizer’s pill stretch back 19 years, to the SARS epidemic. Early last year, Pfizer began modifying the drug’s design so that it could be used to fight Covid and taken as a pill rather than intravenously.Pfizer’s drug is in the class of so-called protease inhibitors that are commonly used to treat H.I.V. and hepatitis C. The drug is designed to stop the coronavirus from replicating by blocking the activity of a key enzyme that the coronavirus uses to replicate inside cells.Pfizer also said that its studies showed that the drug was safe and did not cause worrisome mutations. Some scientists have raised that concern about Merck’s pill, which works by inserting errors into the virus’s genetic code to stop it from replicating. Pfizer’s pill doesn’t do that.Britain, which on Thursday became the first government to authorize Merck’s pill, recommended that it not be used in women who are pregnant, breastfeeding or who could become pregnant during the period.Carl Zimmer