Some patients are struggling to get new COVID-19 shots

Earlier this month, FDA approved new COVID-19 vaccines targeting the XBB.1.5 omicron subvariant developed by Moderna and Pfizer-BioNTech. CDC has also recommended all Americans ages 6 months and older are recommended to get at least one dose of the new COVID-19 vaccine.

However, the rollout for these new shots has been rocky, with numerous people reporting that they were either turned away or had their vaccine appointments cancelled.

"I'm just frustrated because I'm a working person, and I have a schedule to maintain," said Amy Imhoff, a 39-year-old digital content manager who had her vaccine appointment at CVS canceled twice. "I need a booster. I don't want to get sick again."

In previous vaccine rollouts, drug manufacturers shipped doses directly to vaccination centers, but now they are sending them to wholesalers, who then ship doses to vaccination sites. Because of this change, delivery delays or a lack of wholesaler supply may be preventing pharmacies from getting vaccine doses.

According to the Wall Street Journal, some health experts have voiced concerns about how these issues will affect vaccine uptake.

"If some of these people are turned away upfront, with the vaccine hesitancy, they may not come back," said Hugh Chancy, a pharmacist and president of the National Community Pharmacists Association.

So far, federal health officials have encouraged patients who want to get vaccinated to keep trying. "If you've had a problem finding the vaccine, stick with it," said CDC Director Mandy Cohen. "More vaccine is on the way."

Insurance coverage for new COVID-19 shots is spotty

Before the end of the public health emergency, the federal government covered the cost of all COVID-19 vaccines. Now, with the vaccines on the commercial market, they are expected to be covered by most public and private health insurances.

However, some insurers only cover the vaccines through in-network providers and pharmacies, limiting the places where patients can get vaccinated at no cost. Other insurances have not yet updated their plans to cover the new shots, leading to coverage denials and high out of pocket costs for some patients.

According to the Washington Post, some patients have been asked to pay up to $200 out of pocket for new COVID-19 vaccines. Other patients have been unable to pay for the vaccines on their own even though they wanted to.

"Nightmare is the first word that comes to mind," said Glen Cotes, who received a message right before his vaccine appointment that the shot would cost $190.99.

Following reports of these insurance denials, CMS has reminded insurers that they must immediately cover the new COVID-19 vaccines without cost-sharing and is working with them to ensure their systems are up to date with new billing codes.

"The Biden Administration will continue working to ensure COVID-19 vaccines are widely available to the American public at no-cost to them from their local provider, community health center or pharmacy," said HHS spokesperson Ilse Zuniga.

For their part, insurers have also said they are working to quickly resolve any COVID-19 vaccine coverage issues.

"We are working closely with the federal government, pharmacies, and other partners to quickly ensure patient access to COVID-19 vaccines with $0 cost sharing and address any issues relating to newly added billing codes quickly," said James Swann, a spokesperson for America's Health Insurance Plans.

Similarly, Michael Bagel, associate VP of public policy at the Alliance of Community Health Plans, said insurers "continue to work through some technical glitches and some supply slowness that continues to get better day by day."

Even with these issues, vaccine advocates continue to encourage people to get vaccinated when they can and to not give up if they face supply or coverage issues.

"I do think this is going to pan out in the next couple of weeks," said Amy Pisani, executive director of the vaccine advocacy organization Vaccinate Your Family. "We are working out the kinks nationwide, and I really hope people circle their calendar and say, 'I'm going to come back in two weeks.'" (Abbott/Mathews, Wall Street Journal, 9/25; Nirappil/Sun, Washington Post, 9/22; Rex, CBS News, 9/19)

Going into the fall, the United States may see a new surge of respiratory viruses, including COVID-19, respiratory syncytial virus (RSV), and influenza. To protect against illness, federal health officials are encouraging people to get vaccinated once new shots against these three viruses are available.