A $40 co-pay highlights barriers to a new flu shot
Robert F. Kennedy Jr. has not nominated new members of the Advisory Committee on Immunization Practices, leaving the federal panel without new vaccine recommendations even as the US Food and Drug Administration approves new vaccines. Experts said US vaccine recommendations are in limbo, access to vaccines is suffering and some of the uncertainty may continue for years. The gap is already affecting insurance coverage, state vaccination rules and access for seniors.
Insurers usually have at least a year after FDA approval to add coverage of a new vaccine to their plans, so a co-pay like Kroening’s is not unusual in the first year or so. When a vaccine is approved for a new group, either because it is new to the market or because the approval expanded to include more people, insurers have a year from the ACIP recommendation to implement coverage by the next plan year, which usually starts in January. A recommendation in December 2026 would require coverage by January 2028; a recommendation in January 2027 would push the requirement to January 2029.
The Guardian reported that experts considered it likely that ACIP would not recommend the new shot by the end of 2026. If that happened, insurers would not be required to cover it until January 2029 at the earliest, leaving the timing of full coverage uncertain.
Congress amended the Affordable Care Act to require coverage of Covid immunizations within 15 days of an ACIP recommendation, the only exception to the coverage timetable. Lindsay Wiley, a professor of law and faculty director of the Health Law and Policy Program at UCLA Law, said, “The legal requirement doesn’t go into effect very quickly. The process takes time.” For the new flu shot, Wiley said, “it seems likely that at best we would get a recommendation next year,” but she said there was “no reason to think” the committee would do so. “It’s just delaying more and more and more,” she said.
Ron Kroening, 63, has asthma and bad allergies this time of year, so his doctor recommended the new Moderna mRNA flu vaccine. The FDA approved it in August for people age 50 and up, and trials suggest it provides stronger protection than traditional flu shots. It took Kroening time to locate the one pharmacy in his area that stocked the shot, and he was shocked to be charged a $40 co-pay.
“I figured that was an error because I’ve never had to pay for a flu shot in my life,” Kroening said. He said his insurer told him the vaccine was not covered because there was no ACIP recommendation: “The reason the mRNA isn’t covered is because it’s not listed as an ACIP vaccine.”
Kroening is a retired public health employee who worked on immunizations at the state level in Oklahoma. He called the co-pay a barrier: “This is really a barrier. And any barrier to immunizations is going to keep people from getting them.” “A $40 co-pay is going to turn people off,” he added, noting that his pharmacist also did not tell him other flu shot options were available.
The absence of recommendations has had effects beyond federal guidance. Some states will not allow pharmacists to give vaccines without an ACIP recommendation. Some decisions made before the committee was disbanded were also halted, including the September 2025 recommendation for new shots to prevent RSV, although insurers appear to be covering them anyway. A now-voided vote to end the universal birth dose of the hepatitis B vaccine is influencing potential state-level laws. There have also been reported delays in insurer coverage for new flu shots for seniors under Medicare, coverage that is mandated by law even without an ACIP recommendation.
As HHS secretary, Kennedy reduced childhood immunization recommendations by a third and replaced ACIP experts with members he selected. A judge’s order halted those changes because they had not been completed correctly. The US government has appealed the part of the order that disbanded the vaccine committee, but experts said nothing prevents Kennedy from beginning the proper appointment process. He has not done so.
Aaron Siri, who has served as Kennedy’s lawyer and has litigated cases against vaccine makers, wrote on Monday: “This White House and DoJ are making no serious attempt to actually revive the vaccine committee.” He added: “It appears the DOJ and the White House are doing everything they can to make sure that there is no functioning vaccine committee.” Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed: “The federal government is choosing not to put in place a new ACIP.”
Reiss said Kennedy’s slate of advisers was clearly “uninformed” about vaccine policy, and she said watching their public meetings was “embarrassing,” even for anti-vaccine activists. She also said there were advantages for Kennedy in not having a functioning ACIP. “Kennedy, in appointing his ACIP, wanted to change the schedule, and they haven’t been anywhere near as quick as he’d like them to be. So, going around ACIP is a plus,” she said. Delaying the reconstitution of the committee may allow him to make his own recommendations, she added.
Even after the lengthy court case concludes, Reiss said ACIP’s future is uncertain because Kennedy had “aggressively undermined” trust in the panel’s independence. “Without dramatic changes, it’s probably not coming back the way it was,” she said. “This has shown that ACIP is politically vulnerable, and I think if we want ACIP to go back to the way it was, we’re going to need a statute that gives it some protection.”
Kroening’s insurer belongs to AHIP, an insurance industry group that vowed to continue covering all shots recommended as of September 2025. Insurers can also choose to cover a vaccine before they are required to do so. “Vaccines are more cost-effective than getting the flu,” Kroening said, and he said he would still choose the new vaccine despite the co-pay. “I’m able to pay the $40, and I’m happy I did, but still not happy that insurance didn’t cover it,” he said. Kroening said he was worried about what the changes meant for the future of immunizations in America. “They’re harder to get now,” he said. “It’s a mess right now, what they’re doing with our vaccines.”