What to know about COVID shots after RFK Jr. changed recommendation
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Getting insurers to cover COVID-19 shots for healthy kids and healthy pregnant women may be much harder now that Health Secretary Robert F. Kennedy Jr. has dropped the CDC's recommendation for those groups.
Why it matters: While most Americans under 65 have stopped seeking out COVID boosters, health experts say the change will erect cost and access hurdles for two groups at greater risk of developing serious complications from the virus.
The big picture: Kennedy began pulling back access to COVID-19 vaccines last week when the Food and Drug Administration began to require drug manufacturers to conduct more studies as a condition for approving updated COVID-19 vaccines for healthy adults under age 65.
- Most doctors and pharmacies would likely still be able to recommend and administer the vaccine off-label to these groups, experts say. However, it's very likely insurance coverage will dry up due to the changes Kennedy made to the recommended vaccine schedule on Tuesday.
What they're saying: "That's now the license recommendation. So anybody who chooses to use the vaccine who's not in a high risk group is using it off-label, which means that it's unlikely to be covered by insurance," said Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia and a member of the FDA's vaccine advisory committee.
- It could mean a 40-year-old mother with a high-risk child who has leukemia may no longer qualify for coverage to get extra protection against the virus, Offit said.
- The insurer trade group AHIP said it was unable to comment on coverage decisions but added it was "reviewing the announcement closely."
It's unclear how much patients would have to pay out of pocket at the doctor's office or pharmacy counter. The Centers for Disease Control and Prevention lists prices for a 10-pack of the vaccine from $58 to $140, but some uninsured patients previously reported prices at the pharmacy counter approaching $200.
- Even if insurers continue paying for the vaccine, the Vaccines for Children Program — which funds CDC recommended vaccines for children in families who don't otherwise have insurance — will likely stop covering the shots, said Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting director of the CDC.
- "For lower income kids, they will not have the choice about about vaccinations, and that is just wrong," he said.
Between the lines: Many Americans have at least some protection from past COVID shots, from having contracted the virus or both. The medical community has also learned a lot about how to temper the damage from the virus.
- But the youngest Americans don't have that same protection and can face risks of serious outcomes, with long COVID still a threat.
- "You have the leading voice for public health in this country basically saying 'children don't need a vaccine and it's just not true," Offit said. Already less than 5% of kids under 5 are getting the COVID shot.
- "Just in the past year, 152 children died from this virus and 40% of them were not in a high-risk group, which is pretty much where we were at the beginning of the pandemic," he said.
Meanwhile, medical organizations raised alarm at recommendations begin pulled for pregnant women. Some noted that pregnancy was listed as a risk factor for developing severe COVID-19 when the Trump administration announced steps to limit the shots to seniors and high-risk patients.
- Pregnant women who are vaccinated are also believed to pass some immunity on to their babies.
