Rosalind Evans
The latest wave of COVID-19 vaccinations in the U.S. has encountered some stumbling blocks, particularly around delayed health insurance coverage for the vaccines.
Private insurers, along with government-funded programs like Medicare, are obligated to cover the costs of the newly released Pfizer and Moderna vaccines. These vaccines, recommended for Americans aged 6 months and older, became available just recently.
Spokespeople from the Centers for Medicare & Medicaid Services (CMS), various private healthcare providers, and CVS have acknowledged these temporary coverage gaps. They clarified that the delays are due to some insurance companies still updating their plans to incorporate the new vaccines. They emphasized that Americans should still be able to get the COVID-19 vaccines at no cost through their insurance.
Recent social media activity reveals that some individuals have been charged between $125 and $190 per dose at pharmacies. Others have been told that their insurance has not yet been updated to cover the new vaccines.
This has led to increasing confusion about the no-cost access to COVID-19 vaccines, even as public health authorities insist that they should be free, especially with COVID-19 cases on the rise nationwide.
The situation arises against the backdrop of a major policy change. The U.S. government is transitioning vaccine distribution to the commercial sector, allowing manufacturers to sell directly to healthcare providers at rates exceeding $120 per dose. This is a departure from the previous model, where the federal government would buy the vaccines at discounted rates for universal distribution.
A representative from CMS stated that the agency is aware of the difficulties some people are facing in obtaining vaccines due to insurance issues. CMS has been closely coordinating with insurance plans for months and is re-engaging with them to ensure systems are ready to cover the new vaccine costs.
A CVS spokesperson informed CNBC that some payers are still in the process of updating their systems to cover the newly approved COVID-19 vaccines. They mentioned that pharmacy teams are prepared to help schedule future appointments for patients whose insurance coverage is currently denied.
Sarah Lindsey, a Florida-based jewelry store owner, took to social media platform X, previously known as Twitter, to call out her insurer, Florida Blue. She said that insured individuals are being told the vaccine isn’t covered and could cost $155, labelling this as unacceptable. A spokesperson for Florida Blue noted that only a “small percentage” have encountered coverage issues and assured that most beneficiaries can access the shots for free.
A representative for Elevance Health encouraged pharmacies to re-file vaccine claims for a $0 copay and expected a quick resolution of these delays.
These coverage gaps are fueling worries that the new vaccines, aimed at targeting the omicron subvariant XBB.1.5, may see slow adoption. This comes as only 17% of Americans, roughly 56 million people, have received Pfizer’s and Moderna’s bivalent COVID boosters since their approval last September, as per data from the Centers for Disease Control and Prevention.
The hiccups in insurance coverage for the new COVID-19 vaccines come at a precarious time, as public health experts are concerned about both pandemic fatigue and the mistaken belief that the COVID crisis has passed. The issues of delayed coverage may compound these challenges, potentially discouraging an already hesitant public from getting vaccinated. It is crucial for all stakeholders, from insurance providers to pharmacies and public health agencies, to promptly resolve these glitches to ensure a smooth and effective vaccination campaign against the evolving threat of COVID-19.
