Patients Pay More for Flu Shots

Ron Kroening, 63, paid a $40 co-pay for a new mRNA flu vaccine at a pharmacy in his area. His insurer declined to cover the cost because the shot is not yet on the federal advisory list. For many Americans, this specific transaction illustrates a growing gap in coverage for newly approved immunizations.

The uncertainty stems from the Advisory Committee on Immunization Practices, or ACIP, which currently has no members. Health and Human Services Secretary Robert F. Kennedy Jr. replaced the previous expert panel with handpicked allies, but a judge halted that change, finding the process was flawed. Kennedy has not nominated new members, leaving the committee empty while new vaccines continue to gain Food and Drug Administration approval.

Under standard insurance rules, companies must cover a vaccine within one year of an ACIP recommendation, typically by the following January. Because the committee is vacant, insurers lack the trigger to start that clock. Lindsay Wiley, a law professor at UCLA, noted that a recommendation in December 2026 would mandate coverage by January 2028. A recommendation in January 2027 would push full coverage to January 2029. Wiley called a recommendation next year the best case scenario but said there is no reason to expect one soon.

This delay affects other medical decisions as well. Some states prohibit pharmacists from administering vaccines without an active ACIP recommendation. A September 2025 recommendation for new RSV shots was halted by the court order, although insurers appear to be covering those shots anyway. A voided vote to end the universal hepatitis B birth dose is also influencing state-level legal debates.

Kroening, a retired public health employee from Oklahoma, said barriers to vaccination often keep people from getting shots. His insurer is part of AHIP, an industry group that promised to keep covering all shots recommended as of September 2025. Insurers can choose to cover vaccines before they are legally required to do so, but they are not doing so uniformly for the new flu shots.

Legal experts say the federal government is choosing not to refill the committee seats. Aaron Siri, a lawyer for Kennedy, wrote on Monday that the White House and the Department of Justice are not making a serious attempt to revive the panel. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the administration is bypassing ACIP. She suggested this allows Kennedy to make his own recommendations without waiting for a formal committee vote.

Reiss warned that trust in the committee’s independence has been undermined, and restoring it may require a new statute. The government has appealed the part of the ruling that disbanded the committee, but experts say nothing prevents Kennedy from following the correct process to appoint new members now. For Kroening, the current situation means paying out of pocket for a shot his doctor recommended for his asthma and allergies.

"It's a mess right now, what they're doing with our vaccines," Kroening said. He said he would still pick the new vaccine and is glad he paid, but he is unhappy that insurance did not cover it.