The launch of the newly approved COVID-19 vaccines, the first campaign since the federal pandemic emergency ended, is off to a bumpy start.
Reports are piling up of insured Americans being stuck with the nearly $200 bill for shots, which were approved last week. The new vaccines are designed to protect against new strains of the coronavirus and are recommended for everyone older than 6 months.
While the Biden administration has scrambled to make the shots accessible to uninsured Americans, it’s unclear whether current supply will meet demand.
Anyone with health insurance — either through private insurers or federal programs like Medicare and Medicaid — should be able to receive the new COVID vaccines for free.
But that’s not always happening, according to news reports and complaints on social media. As CBS News reported, the vaccines have new billing codes, and insurers are still updating their plans to cover the shots.
Major health insurance providers, including Blue Cross Blue Shield, Aetna and Kaiser Permanente, said they planned to cover the COVID-19 shots as routine vaccinations when reached for comment by The Hill. Providers like Cigna and Anthem did not immediately respond when reached for comment or deferred inquiries to AHIP, the health insurance trade association.
“Health insurance providers are working with the federal government and pharmacy and provider partners to ensure that everyone has access to ACIP-recommended vaccines, without cost sharing,” AHIP said in a statement to The Hill.
“The new vaccine formulations mark the first time that the COVID-19 vaccines are available without being purchased/distributed by the federal government.”
Health and Human Services Secretary Xavier Becerra received his updated COVID shot at a CVS Pharmacy in Washington on Wednesday to encourage vaccine uptake and promote the availability of vaccines through pharmacies.
While taking questions from reporters, Becerra acknowledged accounts of insured individuals having to pay out-of-pocket. The secretary said any claims that insurers aren’t covering the shots are “not correct.”
“Please make sure you’re talking to your insurance company because. You should be covered by law. If you are insured, you are covered for COVID. If you are on Medicare, you are covered. If you are on Medicaid, you are covered and if you don’t have insurance — through this Bridge Access program — you are covered,” Becerra said.
He also encouraged insured customers to speak with their pharmacists because they may be able to clear up any confusion.
“We’ve contacted the insurers and contacted the pharmacists and we’re working with them to make sure everyone understands how this works,” Becerra said.
For the uninsured, the Biden administration has quickly expanded pathways to deliver COVID-19 vaccinations. The initiative, called the Bridge Access Program, will distribute vaccines through community health centers, local health departments and pharmacies.
There were initial concerns that contracts with pharmacies in the Bridge program — CVS, Walgreens and eTrueNorth — might not be finalized until October, but the CDC announced last week that existing contracts had been modified to offer the shots in areas with low coverage and access.
HHS estimates more than 20,000 retail pharmacy locations across the U.S. will offer no-cost vaccinations through this Bridge program, scheduled to run until December 2024.
But community health centers and local health departments are also adjusting to a COVID response without the federal funds they enjoyed during the pandemic to help administer doses.
According to Lori Freeman, CEO of the National Association of County and City Health Officials (NACCHO), health centers lack both the resources and the supply that they previously benefited from.
“There will be about 6 million vaccines available and those initial vaccines are targeted towards the uninsured and underinsured folks through what is called the Bridge Program,” Freeman said.
“Three million will be available to state and local health departments through federally qualified health centers and through the regional community health centers. And so there’s going to be less vaccines and there are about 25 million total uninsured people in the country right now. So you can easily do the math.”
Health stakeholders are also still unclear on what level of demand they should anticipate for the shots, though Freeman said member departments within her organization have been receiving increasing rates of phone calls about obtaining a vaccine since the CDC approved them.
HHS has not disclosed how many vaccines will be made available through the Bridge program, and Becerra did not provide a figure when asked directly about quantity on Wednesday.
“This is a billion-plus dollar program. As I said, you don’t have to pay out of pocket for your vaccine but it is not … it’s not cost-free. There are costs to making a vaccine available,” he said.
The secretary said the CDC will be paying a similar price per vaccine dose as it did in the past. The federal government previously paid roughly $20 per dose for the first round of coronavirus immunizations. The updated vaccines from Pfizer and Moderna are priced at $120 and $129, respectively, on the commercial market.
Many health departments may not be able to cover the costs of these newer formulations, according to Freeman, even with reimbursements.
“Some of the challenges we’re seeing specifically with the local health departments’ involvement are that there are some billing issues with the vaccine in that the reimbursement available to local health departments is less than the cost of the vaccine,” Freeman said.
She noted one reimbursement rate she has been told of is $65 for every $120 dose.
Freeman added not all the doses allocated for the Bridge program will be immediately available, so health departments in areas with high rates of uninsured individuals may contend with low supply as manufacturers and distributors get the medicine out.
Still, Becerra projected confidence in vaccine access, saying that these early hiccups will be overcome soon.
“We’ve been working with the insurers for months and the pharmacist for months. We had to reach contracts with the various stakeholders. So, everyone’s known but sometimes whether it’s a computer glitch or maybe something else, something can get in the way,” said Becerra. “My sense is that these are glitches that will be addressed pretty quickly.”
