Updated COVID-19 Vaccines Face Coverage Hurdles for Some Medicare Recipients
The rollout of updated COVID-19 vaccines is encountering obstacles for certain Medicare beneficiaries, with reports emerging of the shots not being covered in some locations despite FDA approval. While federal guidelines state medicare has the authority to cover vaccines once approved by the FDA, access remains inconsistent across the country.Concerns about access extend beyond Medicare recipients. Limited initial eligibility raised questions about vaccine availability for individuals outside high-risk groups, though officials state “Anybody can get the booster” and “Most Americans will be able to get it from their pharmacy.”
the situation is further complicated by varying pharmacy policies.CVS, a major national chain, requires a doctor’s prescription for all patients-including Medicare beneficiaries-in 13 states and Washington, D.C., until the CDC‘s Advisory Committee on Immunization Practices (ACIP) issues its recommendations. Even after ACIP acts, eligibility at CVS will be age-dependent in those locations.In Massachusetts,Nevada,and New Mexico,CVS will not offer the updated COVID-19 shot at all until ACIP provides guidance.
A CVS spokesperson, Amy Thibault, acknowledged some Medicare patients have been told the vaccine isn’t covered, attributing the issue to payers still updating their systems. “A few payers are still updating their systems and may not yet be set up to cover the updated Covid-19 vaccines,” Thibault said, adding that pharmacy teams can reschedule appointments for patients facing coverage issues.
Walgreens has not yet responded to requests for comment.
The CDC’s ACIP typically issues its COVID vaccine recommendations earlier in the summer, but this year is not scheduled to meet until September 18.
Arthur Caplan, head of the division of medical ethics at NYU Langone Medical Center in New York City, expressed concern that difficulties accessing vaccines for eligible patients could signal broader access issues under shifting policies. ”Medicare should be covering the shots,but it isn’t clearing people,” Caplan said.”so again, this just stirs up uncertainty about, ’OK, am I eligible? Am I in the risk group?’ People still aren’t sure.”
The Centers for medicare and Medicaid Services stated it is indeed investigating the coverage issues.”CMS continues to monitor developments related to COVID-19 vaccines,” a spokesperson said in a statement.
updated COVID shots began arriving at major pharmacy chains last week.
