Some patients experience delays in their insurance coverage

Pharmacist Ani Martirosyan administers a vaccination to a patient at a CVS on Tuesday, September 12, 2023 in Glendale, California.

Brian Van Der Brug | Los Angeles Times | Getty Images

The rollout of a new round of Covid vaccines in the United States is off to a rocky start, as some patients report delays in health insurance coverage for the shots.

Private insurance plans and government payers such as Medicare are required to cover new vaccines from Pfizer And Modern, which became available late last week. U.S. regulators have recommended that all Americans aged 6 months and older receive the new round of vaccines.

The Centers for Medicare & Medicaid Services, certain private health care providers and CVS confirmed temporary coverage delays and emphasized that Americans can access Covid vaccines for free through insurance plans. They said the reason for the delays was that some insurers were still working to update their plans to include the new vaccines.

Dozen of posts Reports posted on social media in recent days show that some patients have been charged between $125 and $190 for an injection at pharmacies. Others have been told their insurance plans don’t yet cover the new vaccines.

The reports fuel confusion among insured patients over whether they can still access Covid vaccines for free – even after public health officials reassured them that they could – even as cases are increasing across the country.

It also comes after a huge change in how Covid vaccines are covered in the United States.

The government is moving vaccines to the commercial market, meaning manufacturers will sell their new vaccines directly to health care providers at more than $120 per dose. Previously, the federal government purchased Covid vaccines directly from manufacturers at a discount to distribute them free to all Americans.

A CMS spokesperson said the agency is “aware that some consumers have had difficulty accessing COVID-19 vaccines, including unexpected denials of insurance coverage at the point of care.”

CMS has been “in close contact with plans regarding these transitions for months” and is reaching out to ensure its systems are “up to date and ready to meet their obligations to provide Covid-19 vaccine coverage to participants.” , beneficiaries and registrants”, according to the spokesperson.

A CVS spokesperson told CNBC that some payers are “still updating their systems and may not yet be set up to cover updated COVID-19 vaccines.” They added that the company’s pharmacy teams can help patients schedule a vaccine appointment at a later date if their coverage is denied.

Florida-based jewelry store owner Sarah Lindsey used her own insurer to add the new Covid vaccines to her formulary.

“Any insured member trying to get it at a pharmacy is being told it is not approved and will cost $155. There is no excuse for this,” she wrote in a Monday message on X, formerly Twitter, tagging Florida Blue, a local Blue Cross. Shield insurer.

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A Florida Blue spokesperson said a “small percentage” of patients are experiencing coverage issues, but the insurer covers injections for most beneficiaries free of charge. All insured patients who have been billed for a Covid injection should contact their pharmacy for reimbursement or file a claim with Florida Blue.

Meanwhile, a spokesperson for a healthcare provider Élevance Santé urged pharmacies to resubmit Covid vaccine requests “so they can be processed with a $0 copay.” They added that they expect the delays in coverage to be resolved quickly.

The media coverage missteps come amid fears that a mix of pandemic fatigue, belief that Covid is “over” and confusion over personal risk levels will hamper uptake of new vaccines , designed to target the omicron XBB.1.5 subvariant.

According to the Centers for Disease Control and Prevention, only 17% of the US population – or about 56 million people – have received the bivalent Covid boosters from Pfizer and Moderna since their approval last September.

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