This fall’s COVID vaccines aren’t always easy to get or get insurance to cover : Shots

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There’s high demand for this fall’s COVID shots, which offer protection against circulating variants of omicron. But there’s been some distribution hiccups.

Rogelio V. Solis/AP


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Rogelio V. Solis/AP


There’s high demand for this fall’s COVID shots, which offer protection against circulating variants of omicron. But there’s been some distribution hiccups.

Rogelio V. Solis/AP

When federal health officials recommended the next round of COVID-19 boosters for anyone 6 months old or older, doses were supposed to be available right away at pharmacies. But two weeks later consumers are reporting problems. Some people are finding some stores just don’t have doses yet, or insurance coverage is not straight-forward.

“The rollout has hit some snags,” says Jennifer Kates, senior vice president and director of the Global Health & HIV Policy Program at the Kaiser Family Foundation or KFF. “On the one hand, some of this was anticipated, but it has seemed to be a little bit more chaotic than expected.

Kates herself was looking to get vaccinated at her pharmacy this week but her appointment got canceled. She tried going in, anyway.

“The very nice pharmacist said, ‘Yeah, we just don’t have the supply. We’re not getting enough in and we’re still letting people schedule appointments,’ ” Kates says.

There’s plenty of demand for the shots. Around half of all U.S. adults intend to get the new COVID vaccine this fall, according to a survey out Wednesday from KFF, including two-thirds of seniors. That’s much higher than the uptake for last year’s bivalent boosters – about 17% of Americans got those.

And the vaccine manufacturers say they’ve got sufficient doses available – the problem seems to be with distribution, Kates explains. Unlike year’s past when the federal government purchased the vaccines and made them free to consumers, this year pharmacies had to buy the vaccines from suppliers.

“This is the first time that the vaccines are being commercialized. They’re being largely procured, supplied, paid for in the private sector. So it’s sort of our health care system as we know it,” Kates says.

The problems include issues with insurance coverage. Since the government is no longer giving the shots away for free most people need to use their health insurance to pay for them. (The federal government is only making the vaccines free for the uninsured, via a temporary program called Bridge Access.)

For those with insurance, whether you have private insurance through your job, or you’re on government sponsored insurance like Medicare, it should be free to you, without copays or charges.

But Kates at KFF says insurers seem to have missed that memo, “or have been slow to get their systems ready to make that an easy process for consumers.” For instance, a colleague of hers tried to get the shot at a pharmacy that was out of network on her plan, and her insurer refused to cover it, “which is actually against federal law and regulations,” she says.

If no pharmacy in your plan’s network has the vaccine, insurers are supposed to cover it even if it’s out of network, Kates says.

The situation is causing pharmacies headaches, too, says John Beckner, who is senior director of strategic initiatives for the National Community Pharmacists Association which represents independent drug stores around the country, including many in rural and urban underserved areas.

Beckner says some pharmacies are running into problems with insurers not reimbursing them for the vaccine. This is probably because many insurance systems haven’t updated their systems to reflect new rules around the vaccine, now that the public health emergency is over, and the federal government is no longer paying for it.

Insurance plans were used to only having to reimburse pharmacies for the administration of the vaccine, not the vaccine product itself. “I don’t think the health insurance plans did a good job of updating their system in anticipation of the vaccine rollout,” he says.

Pharmacies will often give the vaccine to consumers even though these issues haven’t been worked out, says Beckner. “Pharmacies are on the hook for that money until it becomes rectified.”

America’s Health Insurance Plans, the trade association for health insurance plans, said in a statement to NPR that insurers are covering the new COVID vaccine, and they say they’re working with pharmacies and government and others to ensure that consumers don’t face any costs.

Pien Huang contributed to this report.

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