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3d ago

FDA’s Narrow COVID Shot Policy for 2025–26 Yields Patchwork Access and Costs

Insurers await ACIP guidance, leaving coverage and access uncertain.

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California is endorsing COVID-19 vaccine recommendations from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, rather than federal health agencies, state officials said Tuesday.
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A vial of Moderna COVID-19 vaccine rests on a table at an inoculation station in Jackson, Miss., on July 19, 2022. (AP Photo/Rogelio V. Solis, File)

Overview

  • The FDA cleared updated COVID-19 vaccines for the 2025–26 season but limited routine eligibility largely to people 65 and older and those with qualifying health risks.
  • Pharmacies report that seniors can generally get vaccinated with insurance coverage, while many younger adults must attest to a medical condition or obtain a prescription depending on state rules.
  • CVS and Walgreens are offering shots to those who qualify, and some younger adults without clear coverage face out-of-pocket prices that can exceed $150.
  • States are moving independently: New Mexico issued a standing order to keep pharmacy access broad, New York authorized pharmacists to prescribe and administer COVID vaccines for 30 days starting Sept. 5, and Massachusetts directed insurers to cover vaccines recommended by the state health department.
  • Experts cite HHS leadership changes and a reported shake-up of the CDC’s ACIP as drivers of confusion, with insurers holding final coverage decisions until the ACIP meeting on Sept. 18–19.