By Naveen Athrappully
Insured Americans are being charged over a hundred dollars for the newly rolled out COVID-19 vaccines as insurers fail to update their plans, with some people deciding against taking jab after learning about the cost.
Several posts on social media claimed that people were being charged for a shot of the new vaccine at pharmacies. “Hey @FLBlue: do your job and add the new, long-awaited Covid-19 vaccine to your pharmaceutical formulary. Any insured member trying to get it at a pharmacy is being told it’s not approved and will cost $155. There’s no excuse for this,” Sarah Lindsey, a jewelry store owner from Florida, said in a Sept. 19 post on X. “FLBlue” refers to Florida Blue, which offers health insurance plans.
Glen Cote from Acton, Massachusetts, received a text on his phone saying that his COVID-19 shot would cost $190.99, according to WBZ-TV. The message came just before his appointment at retail pharmacy chain CVS for the jab. Mr. Cote, who is covered by the state Medicaid program MassHealth, went on to cancel the appointment.
According to the Centers for Medicare and Medicaid Services (CMS) and CVS, the new COVID-19 vaccines have a revised billing code for insurers, which the firms are yet to update for their plans. This has led to many people getting wrongfully charged for the shot, it stated.
“Some payers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines. If this happens, our pharmacy teams can help patients schedule an appointment for a later date,” a CVS spokesperson stated, according to CBS.
The COVID-19 Public Health Emergency (PHE) ended in May this year. During the PHE, the government purchased the vaccines at a discount from manufacturers and distributed them to Americans for free. With the end of the PHE, the shots have moved to the commercial market.
In a statement to The Hill, America’s Health Insurance Plans (AHIP), a trade association of insurance firms, said that insurance providers “are working with the federal government and pharmacy and provider partners to ensure that everyone has access to ACIP-recommended vaccines, without cost sharing.”
“The new vaccine formulations mark the first time that the COVID-19 vaccines are available without being purchased/distributed by the federal government.”
With the end of PHE, individuals without health insurance can now only get access to free COVID-19 vaccines through the U.S. Centers for Disease Control and Prevention’s (CDC) Bridge Access Program.
The initiative “provides no-cost COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs. No-cost COVID-19 vaccines through this program will be available until December 31, 2024.”
The CDC estimates that there are 25 to 30 million American adults without health insurance.
Speaking to reporters on Wednesday, Health and Human Services Secretary Xavier Becerra said that the Bridge Access Program is “a billion-plus dollar program” and pointed out that the CDC will be paying a similar price for the vaccine as it did in the past.
During the first round of vaccinations, the federal government had paid $20 per dose. The new vaccines in the commercial market exceed $100 a dose, with Pfizer charging $120 and Moderna $129 per shot.
“You don’t have to pay out of pocket for your vaccine. But it is not … it’s not cost-free. There are costs to making a vaccine available,” said Mr. Becerra, according to The Hill.
The new COVID-19 vaccines from Pfizer and Moderna were approved by the U.S. Food and Drug Administration (FDA) on Sept. 11, with the shots made available for use among Americans as young as 6 months old.
Dr. Peter Marks, a top FDA official, insisted that vaccination is “critical” for protecting against COVID-19 hospitalization and death.
However, many critics, including experts, have come forth with recommendations advising against taking the vaccine.
The Florida Department of Health issued a warning against the new vaccines on Sept. 13. In a guidance (pdf), it pointed out that “the most recent booster approval was granted in the absence of any meaningful booster-specific clinical trial data performed in humans.”
“Based on the high rate of global immunity and currently available data, the State Surgeon General recommends against the COVID-19 booster for individuals under 65. Individuals 65 and older should discuss this information with their health care provider, including potential concerns outlined in this guidance.”
The department pointed out that mRNA vaccines pose a risk of clinical myocarditis and cardiovascular issues among “otherwise healthy individuals” and that there is an “unknown risk of potential adverse impacts” with each additional shot of mRNA COVID-19 vaccines.
The spike protein in these vaccines may persist among some individuals “for an indefinite period of time,” posing health risks.
The department noted that several studies have found mRNA COVID-19 vaccines to be associated with “negative effectiveness” after four to six months.
“As efficacy waned, studies showed that COVID-19 vaccinated individuals developed an increased risk for infection. This is not found in other vaccines, including the flu vaccine.”
A new study funded by Pfizer found the company’s COVID-19 vaccine did not perform well in children under 5.
Children aged 6 months to 4 years are supposed to receive three shots of the Pfizer-BioNTech vaccine. The number was increased from two when early testing showed little effectiveness.
Three doses of the Pfizer vaccine provided little protection against emergency room visits, urgent care encounters, or outpatient visits, according to the new study.
Pfizer’s vaccine was authorized for children despite unreliable efficacy estimates against infection, and no efficacy estimates against severe disease.
Zachary Stieber contributed to the report.