Some patients see insurance coverage delays

The rollout of a latest round of Covid vaccines within the U.S. is off to a bumpy start as some patients report delays in medical insurance coverage for the shots. 

Private insurance coverage and government payers akin to Medicare are required to cover the brand new jabs from Pfizer and Moderna, which became available late last week. U.S. regulators have really useful all Americans ages 6 months and up get the brand new round of vaccines. 

The Centers for Medicare and Medicaid Services, some private health care providers and CVS confirmed the temporary delays in coverage and emphasized that Americans can access Covid vaccines for free of charge through insurance coverage. They said the explanation for the delays is that some insurers are still working to update their plans to incorporate the brand new vaccines.

Dozens of posts on social media in recent days show some patients were charged anywhere between $125 and $190 for a shot at pharmacies. Others were told their insurance coverage aren’t covering the brand new vaccines yet. 

The reports are fueling confusion amongst insured patients about whether or not they can still access Covid shots free of charge – even after public health officials have reassured them that they’ll — just as cases tick up across the country.

It also comes after an enormous shift in how Covid vaccines are covered within the U.S.

The federal government is shifting shots to the business market, which implies manufacturers will sell their latest jabs on to health care providers at greater than $120 per dose. Previously, the federal government purchased Covid vaccines directly from manufacturers at a reduction to distribute to all Americans free of charge.

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

CMS has been in “close contact with the plans about these transitions for months,” and is reaching out again to be sure that their systems are “up-to-date and ready to satisfy their obligations to offer coverage of Covid-19 vaccines for participants, beneficiaries, and enrollees,” in keeping with the spokesperson. 

A spokesperson for CVS told CNBC that some payers “are still updating their systems and should not yet be set as much as cover the updated COVID-19 vaccines.” They added that the corporate’s pharmacy teams might help patients schedule a vaccine appointment for a later date if their coverage is denied. 

Sarah Lindsey, an owner of a Florida-based jewelry store, called on her own insurer so as to add the brand new Covid shots to its formulary. 

“Any insured member attempting to get it at a pharmacy is being told it isn’t approved and can cost $155. There is not any excuse for this,” she wrote Monday in a post on X, tagging Florida Blue, a neighborhood Blue Cross Blue Shield insurer. 

A spokesperson for Florida Blue said a “small percentage” of patients experienced issues with coverage, however the insurer does cover the shots for many beneficiaries for free of charge. Any insured patients who were charged for a Covid shot should contact their pharmacy for reimbursement or file a claim with Florida Blue.

Meanwhile, a spokesperson for health care provider Elevance Health urged pharmacies to resubmit Covid vaccine claims “so that they may be processed at a $0 copay.” They added that they expect the delays in coverage to be resolved quickly.

The coverage missteps come amid concerns that a combination of pandemic fatigue, the assumption that Covid is “over” and confusion over personal risk levels will hinder the uptake of the brand new vaccines, that are designed to focus on the omicron subvariant XBB.1.5. 

Only 17% of the U.S. population — around 56 million people — have received Pfizer and Moderna’s bivalent Covid boosters since they were approved last September, in keeping with the Centers for Disease Control and Prevention.