40-dollar gap: Patients pay more for flu shots as vaccine panel stays empty

A 63-year-old asthma patient in Cobb County recently paid a $40 co-pay for a new flu shot because his insurance did not cover it. Ron Kroening was told by his doctor to use Moderna’s mRNA vaccine, which the FDA approved in August for adults 50 and older. He found the shot at only one local pharmacy. His insurer, a member of the American Health Insurance Plans (AHIP), denied coverage because the vaccine is not on the Advisory Committee on Immunization Practices (ACIP) list. The committee has been empty since a federal judge halted the changes made by Health and Human Services Secretary Robert F. Kennedy Jr.

Kennedy cut childhood immunization recommendations by a third and replaced ACIP experts with allies. A court order found those changes were not carried out correctly. Kennedy has not nominated new members. As a result, no fresh recommendations are emerging even as new vaccines win approval. This creates a gap between FDA approval and insurance coverage that was not present in previous years.

Insurers typically wait for an ACIP recommendation before adding a new vaccine to their plans. The law gives them until the start of the next plan year, usually January. A recommendation in December 2026 would require coverage by January 2028. A recommendation in January 2027 would push coverage to January 2029. Lindsay Wiley, a law professor at UCLA, said the legal requirement does not take effect quickly. She called a recommendation next year the best case for the new flu shot, but said there is no reason to expect one.

The situation affects more than just flu shots. Some states bar pharmacists from giving vaccines without an ACIP recommendation. Decisions made before the committee was disbanded were also halted. This includes a September 2025 recommendation on new RSV shots, though insurers appear to be covering them anyway. Delays have been reported in Medicare coverage of the new flu shots for seniors, even though the law requires it without a recommendation. The government has appealed the part of the ruling that disbanded the committee.

Aaron Siri, who has served as Kennedy’s lawyer, wrote on Monday that the White House and the Department of Justice are making no serious attempt to revive the committee. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the federal government is choosing not to install a new ACIP. She said an empty committee may suit Kennedy, whose appointees did not move as quickly as he wanted to change the schedule. Bypassing ACIP could let him make his own recommendations. She warned that the committee’s future is shaky even after the court case ends because trust in its independence has been undermined. Restoring it may require a statute giving it protection.

Kroening said he would still pick the new vaccine and is glad he paid, but is unhappy that insurance did not cover it. "It's a mess right now, what they're doing with our vaccines," he said. His insurer has vowed to keep covering all shots recommended as of September 2025. Insurers can also choose to cover vaccines before they must. Kroening is waiting to see if his plan will update its list in the coming months.