40 Dollar Cost: New Flu Shots Hit Patients as Vaccine Panel Stays Empty

A 63 year old asthma patient in Hamilton County recently paid a $40 co-pay for a new mRNA flu vaccine that his insurer declined to cover. The shot was approved by the Food and Drug Administration in August for adults over 50, but because it has not been recommended by the federal Advisory Committee on Immunization Practices, or ACIP, it does not yet qualify for standard insurance benefits.

The delay stems from a legal and administrative standstill at the Department of Health and Human Services. Secretary Robert F. Kennedy Jr. overhauled the vaccine committee earlier in the year, replacing its experts with allies. A federal judge later halted those changes, ruling that they were not implemented correctly. Kennedy has not nominated new members to the panel since the ruling, leaving the body effectively empty.

The timeline for coverage is now uncertain. Insurers typically have one year from an ACIP recommendation to add a vaccine to their plans, with coverage usually starting in January. A recommendation issued 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 does not activate quickly. She called a recommendation next year the best case scenario but said there is no reason to expect one.

The situation is not unique to flu shots. Some states prevent pharmacists from administering vaccines without an ACIP recommendation. A September 2025 recommendation for new RSV vaccines was also halted by the court, though insurers appear to be covering those shots anyway. Medicare coverage for the new flu shots has also seen reported delays, even though federal law requires coverage for seniors without a formal committee vote.

The government has appealed the portion of 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. She warned that the committee's independence has been undermined, potentially requiring new legislation to restore it.

Patients are feeling the impact immediately. Ron Kroening, a retired public health employee, said his doctor suggested the new Moderna vaccine due to its stronger protection in trials. He had to search for a specific pharmacy that stocked the shot. Although his insurer belongs to the industry group AHIP, which vowed to keep covering shots recommended as of September 2025, his new vaccine fell outside that scope. Kroening said he would choose the new vaccine again and was glad he paid for it, but he remains unhappy that insurance did not cover the cost.