2023-09-25 19:17:00
MONDAY, Sept. 25, 2023 (HealthDay News) — Americans seeking new booster doses of COVID vaccines are limited by health insurance complications and delivery delays. Some insurers have refused to cover vaccines, with people showing up for their appointments only to be told they will have to pay $100 or more out of pocket for the shot. And in other places, there are simply no appointments available for booster shots due to a lack of supply. The situation is largely due to a change in COVID vaccine distribution that occurred following the end of the pandemic emergency, according to experts. “When new policies are being implemented, there is always an adaptation period “We are moving from the public health emergency to using normal processes to cover vaccines,” said Arielle Kane, director of Medicaid initiatives for Families USA, a nonprofit consumer health advisory group. Jennifer Kates, senior vice president and director of global health and HIV policy for KFF, said that “we are seeing, with this COVID vaccine, the commercialization process in real time.” “So far, all vaccine purchases and all payments have been made by the federal government,” Kates said. “The government bought all the vaccines. The government ordered and bought all the vaccines and provided them for free to anyone who needed them.” Now it’s basically being transferred to the private sector, and the private sector, the insurers in conjunction with pharmacists and others, you have to order a vaccine and deal with the nuances of the insurance system,” Kates said. Kates, who works in Washington, D.C., has had trouble finding a COVID vaccine booster dose for herself. “I have an appointment next week,” he said. The two companies that make the approved COVID vaccine boosters, Moderna and Pfizer, have said they have enough doses for everyone, according to Kates. Pfizer has shipped several million doses of its vaccine , while Moderna had 6 million doses available as of the end of this week, according to the Associated Press news agency. However, some pharmacies and health networks do not appear to have ordered enough vaccines or to have fully established the supply system to administer them. “They have said they have enough supply,” Kates said. “But they will respond to orders placed by the private sector. Companies and organizations have to order the vaccines, which then have to be sent to them.” CVS Pharmacy told CNN it has had to reschedule some appointments as it receives vaccines on an ongoing basis. Walgreens, Rite Aid and Walmart reported similar problems as they worked to guarantee their supplies. Insurance companies have also contributed to the confusion. Some insurers are still in the process of updating their billing systems to cover the vaccines, he said Matt Blanchette, a spokesman for CVS Pharmacy, told the Associated Press (AP). “Even though insurers and pharmacies have known this was going to happen for a long time, the federal government has been talking to them regarding it for months, almost a year, but some say their systems are not ready yet,” Kates said. Other insurers are reluctant to pay for COVID vaccines, which under the Affordable Care Act should be covered at no cost by almost all insurance as well as Medicare and Medicaid, Kates said. “Anyone on a private plan is covered,” Kates said. “You are entitled to a COVID vaccine at no cost, since they became available.” Kira Kiessling, a resident of Washington, DC, booked a COVID vaccine appointment in anticipation of an upcoming business trip, but the pharmacy told her she would have Kiessling called her insurance company, CareFirst Blue Cross and Blue Shield, and was told the company was having a network-wide problem with billing for the vaccines. “How many millions of people are going to try to get vaccinated and then get discouraged or angry and just not do it?” Kiessling said. Kates said it’s very clear that insurers are required to cover these vaccines free of charge, but there has been some confusion regarding this. “There have been these anecdotal reports of insurers saying no, we won’t cover it yet. We have this window of time before we have to do it. And that doesn’t really fall under the requirement,” Kates said. The U.S. Department of Health and Human Services The US published a frequently asked questions and answers sheet indicating that the new COVID vaccines qualify for immediate coverage by insurance, without any waiting period, Kates said. “We’ve heard these stories, and we’ve reached out to insurers. “We have reached out to pharmacists and are working with them, and to make sure everyone understands how this works, you shouldn’t have to pay out of pocket if you are insured,” said U.S. Secretary of Health and Human Services Xavier Becerra, at a press event Wednesday where he was administered his COVID and flu vaccines. The industry group America’s Health Insurance Plans (AHIP) issued a statement noting that “health insurance providers Health recognize the importance of these vaccines and continue to encourage everyone to receive a COVID-19 vaccine.” “AHIP members are covering the new COVID-19 vaccines with no copays when obtained through an in-network provider “said the statement. “We are working closely with the federal government, pharmacies and other partners to quickly ensure patient access to COVID-19 vaccines without copays and resolve any issues related to the new billing codes quickly.” pocket to receive their COVID dose should be able to be reimbursed by their private insurance, Kates said. Those with an appointment to receive a booster should call their insurance company in advance, to make sure they will not face problems at the clinic or pharmacy, Kates suggested. Both Kates and Kane hope these insurance and supply issues will be resolved quickly. “I imagine this will be resolved and smoothed out over the next week or two, it will get easier,” Kates said. However, both are concerned that people who are not very motivated to get the COVID vaccine booster will see these difficulties as a reason to refuse the shot. “It’s really important that we solve these problems, because when you have the casual user in the pharmacy who sees a sign that says ‘COVID Vaccines Available Here,’ you don’t want that person to say, ‘Hey, I’ll get a COVID vaccine,’ and be told they have a $115 copay, because that person isn’t going to try once more,” Kane said. Kane noted that some major retail pharmacies are also receiving doses from the federal government intended to be offered free to the uninsured. “Uninsured people may not know there is a way to get the vaccine at no cost. Not only is there the retail program, there are also community health centers across the country with resources to give uninsured people the vaccines,” Kane said. More information The U.S. Centers for Disease Control and Prevention can help consumers find COVID vaccines in their community.SOURCES: Arielle Kane, MPP, director, Medicaid initiatives, Families USA; Jennifer Kates, PhD, senior vice president and director, global health and HIV policy, KFF; Associated Press ;CNN.
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