Empty Vaccine Panel Forces Patients to Pay $40 for New Flu Shots

Patients are currently paying $40 out of pocket for a new flu vaccine because the federal committee that dictates insurance coverage is empty. This cost burden stems from the vacancy at the Advisory Committee on Immunization Practices, or ACIP, which prevents insurers from formally covering the latest immunizations.

Robert F. Kennedy Jr., the Secretary of Health and Human Services, restructured the agency's vaccination policy by cutting childhood immunization recommendations by a third. He replaced independent experts on ACIP with handpicked allies. A judge recently halted these changes, ruling that they were not implemented correctly. Kennedy has not nominated new members to the committee, so no fresh recommendations are being issued even as new vaccines receive approval.

The financial impact is visible in the healthcare market. Ron Kroening, 63, has asthma and seasonal allergies. His doctor recommended Moderna's new mRNA flu vaccine, which the Food and Drug Administration approved in August for adults 50 and older. Clinical trials indicate this shot provides stronger protection than traditional formulations. Kroening found the vaccine at a single local pharmacy and paid a $40 co-pay. His insurer denied coverage because the shot is not yet listed as an ACIP vaccine.

Insurance companies typically have one year or more to add coverage for a new vaccine. An initial co-pay is not unusual in the first few months. The current uncertainty lies in the timeline for full coverage. Insurers must cover a vaccine by the next plan year, usually January, following an ACIP recommendation. A recommendation in December 2026 would require coverage by January 2028. A recommendation in January 2027 would push that deadline to January 2029.

Lindsay Wiley, a law professor at UCLA, noted that the legal requirement for coverage does not take effect immediately. She described a recommendation next year as the best-case scenario for the new flu shot. However, she said there is no reason to expect such a recommendation soon.

Coronavirus vaccines are an exception. Congress amended the Affordable Care Act to require coverage within 15 days of an ACIP recommendation for those shots. The delay affects other vaccines as well. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. The committee's September 2025 recommendation on new RSV shots was halted by the court order, though insurers are covering them anyway. A voided vote to end the universal hepatitis B birth dose is now influencing potential state laws. Medicare coverage for the new flu shots for seniors has also faced delays, despite a law requiring coverage without a committee recommendation.

The government appealed the ruling that disbanded the committee. 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 federal government is choosing not to install a new ACIP. Reiss suggested that an empty committee may suit Kennedy, whose appointees did not move as quickly as he wanted to change the schedule. Bypassing ACIP could allow him to make his own recommendations. She warned that trust in the committee's independence has been undermined, and restoring it may require a statute giving it protection.

Kroening's insurer belongs to the Association for Health Care Insurance and Providers, or AHIP. The group has vowed to keep covering all shots recommended as of September 2025. Insurers can choose to cover vaccines before they are legally required to do so. Kroening said he would still pick the new vaccine and is glad he paid, but is unhappy that insurance did not cover it. "It's a mess right now, what they're doing with our vaccines," he said.