Drugstores are gearing up to provide updated COVID-19 vaccines this fall, while insurers plan to cover the costs, despite a recent recommendation from a key government committee that has raised questions.
Last Friday, a panel of vaccine advisers, appointed by Health Secretary Robert F. Kennedy Jr., stopped short of endorsing the new vaccines. Instead, they suggested that individuals could decide for themselves whether to get vaccinated. Generally, the recommendations from these advisers are likely to get approved by the Centers for Disease Control and Prevention (CDC), setting the stage for insurance coverage and access through pharmacies—where most people get their shots.
As we move into the later summer and early fall, many will be looking to get vaccinations to prepare for any potential winter outbreaks.
### Will Insurers Continue to Cover the Vaccines?
It’s expected that most insurers will maintain coverage for these vaccines, but it’s wise to double-check with your insurance provider. The Department of Health and Human Services has reassured that immunization will be covered through various payment methods, including Medicaid and commercial insurance plans.
The Vaccines for Children program, which provides funding for about half of childhood vaccinations in the U.S. each year, typically covers any vaccines recommended by the CDC. A trade group representing major insurers confirmed that its members will cover the vaccines at no cost to patients through 2026, with the exception of UnitedHealthcare, which will also offer coverage for its commercial plans, including those for individuals and small businesses.
However, larger employers will have the discretion to decide on vaccine coverage for their employees. They may be inclined to continue offering it since vaccines can help prevent costly hospital stays due to severe COVID-19 cases.
### Where Can People Get Vaccinated?
Statistics show that roughly two-thirds of adults get their COVID-19 vaccines from pharmacies, while about 30% visit doctors’ offices. Access to vaccinations has improved significantly, overcoming initial challenges that required some individuals to travel to neighboring states for appointments.
Major pharmacy chains like CVS are prepared with enough stock to administer vaccines in every state, although some areas, including Washington, D.C., and a few states like Florida and Georgia, may still require prescriptions. Walgreens also follows this guideline in certain regions.
### Who Is Eligible for the Vaccine?
Currently, the U.S. recommends annual COVID-19 vaccines for everyone aged six months and older. The recent FDA approvals allow vaccinations for individuals aged 65 and older, as well as for younger adults and children with underlying health conditions that increase their risk for serious illness.
The CDC has a detailed list of high-risk conditions, which include asthma, heart problems, obesity, and a range of others. Individuals unsure of their risk status should consult with their healthcare provider. Both CVS and Walgreens have stated that they will inquire about these health factors, but won’t require proof. They maintain a straightforward approach—if a patient believes they qualify, they can receive the vaccine.
In summary, as we approach the vaccine rollout this fall, both drugstores and insurers appear committed to making vaccinations accessible while individuals consider their personal health choices.
