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Pharmacies’ Online Rules Lag State Orders as Insurers Pledge Coverage for 2025–26 COVID Shots

Insurers and federal officials signal payment will continue even as federal guidance narrows routine eligibility.

Overview

  • Vaccine advisers selected by Health Secretary Robert F. Kennedy Jr. declined a broad recommendation, leaving individual decision-making in place pending CDC director sign-off.
  • HHS said the committee’s action preserves coverage across Medicaid, CHIP, marketplace plans and the Vaccines for Children program, and AHIP members plan no‑cost coverage through 2026 with UnitedHealthcare also covering standard commercial plans.
  • FDA authorization for 2025–26 shots covers everyone 65 and older as well as younger people and children with qualifying high‑risk conditions.
  • At least 16 states have issued standing orders allowing anyone to receive a COVID‑19 shot, but a Lever review found CVS, Walgreens, Walmart and Kroger still display restrictive online eligibility or block some bookings even where access is allowed.
  • CVS and Walgreens say patients under 65 will be asked about risk factors without proof and report they can vaccinate in all 50 states and D.C., though prescriptions are still required in a few jurisdictions where state rules demand them.