Drugstores are set to provide updated COVID-19 vaccines this fall, and insurers are expected to cover them, even though an influential government advisory group has not formally recommended these shots.
On Friday, vaccine advisers appointed by Health Secretary Robert F. Kennedy Jr. chose not to provide a specific recommendation but did indicate that individuals are free to decide for themselves whether to get vaccinated.
Typically, recommendations from this advisory group to the Centers for Disease Control and Prevention need the agency director’s approval, but they are generally accepted.
While these recommendations usually kickstart insurance coverage and enable pharmacies in many states to administer vaccines, officials have stated that coverage will persist, with various states maintaining vaccine access through pharmacies—often the preferred location for receiving vaccines.
As winter approaches, many people begin seeking vaccinations in late summer or early fall to protect themselves from potential surges.
Will insurers cover these shots?
Most insurers are anticipated to cover these shots, but it’s wise to double-check with your provider.
The Department of Health and Human Services noted that the committee’s vote ensures continued immunization coverage through various payment methods. A spokesperson clarified that this includes Medicaid, the Children’s Health Insurance Program, commercial coverage via health insurance marketplaces, and the federal Vaccines for Children program, which funds around half of childhood vaccinations in the U.S. annually.
The VFC program typically covers any vaccines recommended by the CDC committee automatically.
The trade association America’s Health Insurance Plans indicated earlier this week that its members will maintain coverage for these vaccines at zero cost to patients through 2026.
This group encompasses every major insurer except UnitedHealthcare, which confirmed it would also continue to cover the vaccine at no cost for its standard commercial plans, available for individuals and small businesses.
However, large employers may determine their own vaccine coverage policies. They may choose to continue this coverage since the vaccines can prevent costly hospital bills from severe COVID-19 cases.
Where people can get vaccinations
According to CDC data, about two-thirds of adults receive COVID-19 vaccinations at pharmacies, while around 30% go to doctors’ offices.
Access to shots has improved after the initial season got off to a rocky start, which saw some individuals traveling to neighboring states for appointments.
Major drugstore chains like CVS claim they are stocked with the latest vaccines and can now administer them in all 50 states and Washington, D.C. In D.C. and a few other states such as Florida and Georgia, prescriptions are required, as stated by CVS Health spokeswoman Amy Thibault.
Walgreens also mandates prescriptions in some states, a company representative noted.
Who can get the shot
Up until now, U.S. health recommendations endorsed annual COVID-19 shots for everyone aged six months and older.
The U.S. Food and Drug Administration has recently authorized the vaccines for individuals aged 65 and older, as well as younger adults and children with conditions that significantly increase their risk of developing severe COVID-19.
The CDC has an extensive list of risk factors, which includes asthma, cancer, heart or lung issues, obesity, depression, and a history of smoking. Additionally, being physically inactive is included, although the agency emphasizes that the list isn’t exhaustive.
Patients may want to consult their healthcare provider to determine their risk level if they do not identify with any of the stated conditions.
Both CVS and Walgreens representatives have mentioned that employees will inquire about risk factors from patients under 65, but proof won’t be necessitated.
“Simply put, if a patient claims they’re eligible, they’ll receive the vaccine,” said Thibault, the spokesperson for CVS Health.
