Earlier this year, the Food and Drug Administration authorized COVID vaccine for people over the age of 65 and those with underlying conditions like asthma and diabetes that put them at increased risk for a serious case of COVID.
Then, drug companies began shipping an updated form of the vaccine, and because it had no blessing from the federal government, state officials said pharmacists could not give shots without a prescription. Ashley Apple is a professor at UVA’s School of Nursing.
“You know that presented a barrier for many patients, because it meant that they would have to reach out to their primary care provider to obtain a prescription, and it’s particularly problematic for those who don’t have a primary care provider.”
So, Apple suggested the state’s health commissioner issue a standing order, lifting the requirement for a prescription if patients were over 65 or had underlying conditions. He did just that, but another question remains. Who will pay? That depends on whether the Advisory Council on Immunization Practices – a branch of the CDC -- recommends the vaccine. If it does, insurance companies and Medicaid would likely cover it.
“And they cover it at zero cost-sharing to the patient, so the patient pays no out-of-pocket to receive the vaccine,” Apple explains.
A decision is expected soon. If it’s no, then private insurers might refuse payment, sticking consumers with a bill of more than $200.
“That’s cost prohibitive for many people,” Apple concludes.
Virginia lawmakers might have to decide whether to authorize more money for Medicaid recipients to be vaccinated.And even if the ACIP recommends the COVID vaccine for everyone, the director of Health and Human Services, Robert F. Kennedy Jr, can override the decision.
