Flu Shots Cost Patients More as Federal Vaccine Panel Remains Empty

Ron Kroening, 63, stood in a pharmacy aisle in October holding a vial of a new mRNA flu vaccine. He paid a $40 co-pay for the shot, a cost his insurance plan did not cover. Kroening has asthma and seasonal allergies, and his doctor recommended the vaccine after the Food and Drug Administration approved it for adults 50 and older in August. The new formula offers stronger protection than traditional flu shots according to trial data, but Kroening had to search for the single local pharmacy that stocked it. His insurer explained that the vaccine is not listed by the Advisory Committee on Immunization Practices, or ACIP, so the plan does not pick up the cost yet.

Kroening is one of many patients navigating a gap in federal health policy. Robert F. Kennedy Jr., the secretary of the Department of Health and Human Services, overhauled vaccination rules earlier in the year. He cut childhood immunization recommendations by one-third and replaced ACIP experts with allies. A judge later halted those changes, ruling that they were not implemented correctly. Kennedy has not nominated new committee members since. As a result, no fresh recommendations are emerging, even as new vaccines win approval from regulators.

The uncertainty affects when insurers must cover new shots. Under current rules, insurers typically have one year from an ACIP recommendation to add coverage by the next plan year. A recommendation made in December 2026 would require coverage by January 2028. A recommendation in January 2027 would push coverage to January 2029. Lindsay Wiley, a law professor at UCLA, noted that these legal timelines do not start quickly. She said a recommendation next year represents the best-case scenario for the new flu shot, but she sees no reason to expect one to happen soon.

The current situation is not the same as a typical delay. Insurers usually take a year or more to update their networks, so an early out-of-pocket cost is not unusual. What differs now is the lack of a start date. Without an ACIP recommendation, the clock for mandatory coverage has not begun. This leaves patients paying full price or partial co-pays for an indefinite period.

Other vaccines face similar hurdles. Some states prohibit pharmacists from administering vaccines unless they have an ACIP recommendation. A September 2025 recommendation for new RSV shots was halted by the court order, though many insurers appear to be covering those shots anyway. A voided vote to end the universal hepatitis B birth dose is also influencing potential state laws. Medicare coverage for the new flu shots for seniors has also been delayed, even though federal law requires coverage without a formal recommendation.

The federal government is appealing the part of the ruling that disbanded the committee. Aaron Siri, a lawyer who has represented 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 administration is choosing not to install a new ACIP. She suggested that an empty committee may suit Kennedy, whose appointees did not move as quickly as he wanted. Bypassing ACIP allows him to make recommendations directly.

Reiss warned that trust in the committee's independence has been weakened. Restoring its full authority may require a statute that gives it legal protection. Kroening's insurer belongs to the industry group AHIP, which has vowed to keep covering shots recommended as of September 2025. Insurers can also choose to cover vaccines before they are legally required to do so. Kroening said he would still pick the new vaccine and is glad he paid for it, but he is unhappy that insurance did not cover the cost.

Kroening described the current state of affairs as a mess. "It's a mess right now, what they're doing with our vaccines," he said. He noted that any barrier to vaccination keeps people from getting shots. Kroening retired from public health work in Oklahoma, where he focused on immunizations. He sees the current gap as a direct result of the administrative vacuum left by the empty committee.