For the first time since the onset of the COVID-19 pandemic, the federal government will not be able to ensure the shots for this fall’s vaccination campaign will be available to the public for free.
When the public health emergency ended in May, so too did the administration’s ability to purchase and distribute shots, tests and treatments for all Americans. The COVID vaccine is now commercialized, just like the flu shot and other vaccines.
Most health plans cover routine vaccines at no cost under the Affordable Care Act, so the majority of people with Medicare or private employer-sponsored insurance won’t face out-of-pocket costs.
But the challenge will be making sure the uninsured — estimated to be about 25 to 30 million people — also have a way to get free shots. The number of people without insurance is also likely climbing due to the ongoing Medicaid “unwinding” that’s intended to remove ineligible people from coverage.
The federal government paid about $29 a dose for last year’s booster shot, but the vaccine manufacturers are charging almost four times that on the commercial market.
Without discounts, Pfizer said its shot will cost $120 per dose, Moderna said it will charge $129 per dose and Novavax will charge $130 per dose.
According to health policy research group KFF, uninsured adults are disproportionately low income, people of color and in poorer health. KFF polling also shows COVID-19 vaccine uptake among uninsured adults is much lower than among those with insurance.
The Biden administration has asked Congress to fund the creation of a “Vaccine for Adults” program that would provide uninsured adults access to all recommended vaccines, including those for COVID-19, at no cost.
But the administration’s most recent budget request for the program was $12 billion over 10 years, and lawmakers have balked at spending more money.
Instead, the administration launched the $1.1 billion “Bridge to Access” program through money that was already appropriated. The program will purchase a limited supply of vaccines and therapeutics and distribute them for free through state and local health departments, as well as pharmacies. But the program is temporary, and will only run through December 2024.
As part of the program, the Centers for Disease Control and Prevention (CDC) is partnering with CVS, Walgreens and eTrueNorth. The agency said it estimates 85 percent of uninsured people live within five miles of a program site where they can receive a free vaccine. The CDC estimated shots will be available this week at participating pharmacies and public health locations.
Yet for the program to be successful, experts said people will need to know it exists, and know where they can get the shots.
The CDC said participating pharmacies are required to conduct outreach to underserved communities, but there are still significant concerns among experts and advocates that underserved populations will fall through the cracks.
“I know the Biden administration has said that people who can’t afford it will have access. But making that happen smoothly is a very different thing,” said Jesse Goodman, an infectious disease specialist and professor of medicine at Georgetown University.
“I do think there’s an equity issue here, and that people who are insured and well-off or older and on Medicare will have access without a lot of fees, but I think a lot of other people won’t. I think for many people … any out of pocket expense right now is a serious disincentive,” Goodman said.
