Vaccine Coverage: Patients Pay Out of Pocket as Federal Panel Remains Empty

Ron Kroening paid $40 out of pocket for a new flu vaccine because his insurer has no clear rule for covering it.

The federal Advisory Committee on Immunization Practices, or ACIP, has been empty since a judge halted a major policy overhaul led by Health and Human Services Secretary Robert F. Kennedy Jr. The committee’s vacancy means no new vaccine recommendations are being issued, even as the Food and Drug Administration approves new shots.

Kennedy cut childhood immunization recommendations by one-third and replaced ACIP members with allies. A federal judge later found the process flawed and stopped the changes. Kennedy has not nominated new members since, leaving the panel without a quorum to vote on new vaccines.

Kroening, a 63-year-old asthma sufferer, received a recommendation from his doctor for Moderna’s mRNA flu vaccine, which the FDA approved in August for adults 50 and older. His insurance company told him the shot was not covered because it was not on the ACIP list. He searched for a pharmacy in his area that stocked the vaccine and paid a $40 co-pay.

Insurers typically wait for an ACIP recommendation before adding new vaccines to their plans. The law generally gives insurers until the next plan year to provide coverage after a recommendation is made. 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 timeline moves slowly. She said a recommendation next year is the best case scenario for the new flu shot, but there is no guarantee one will happen soon. Congress created a faster timeline for COVID-19 vaccines, requiring coverage within 15 days of an ACIP recommendation, but other vaccines do not have that protection.

An empty committee also affects how states regulate vaccine distribution. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. The court also halted a September 2025 recommendation for new RSV shots, though many insurers are covering them anyway. Delays have also appeared in Medicare coverage for new senior flu shots.

Aaron Siri, who has served as Kennedy’s lawyer, wrote on Monday that the White House and the Department of Justice are not making a serious effort to revive the committee. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the government is choosing to keep the panel empty. Reiss warned that even if the committee is restored, its independence may be damaged. Kroening said he would choose the new vaccine again, but he is unhappy that his insurance did not pay for it. "It's a mess right now, what they're doing with our vaccines," he said.