Some health plans slow to cover new COVID booster

Updated COVID-19 boosters have started rolling out to pharmacies nationwide, but some individuals are reporting a high price tag associated with getting a shot.

CBS News Boston reported Sept. 19 that individuals covered by Medicaid and others across social media have reported getting charged for the new vaccine, up to $190.

COVID-19 vaccines were free under the public health emergency and are still covered by most commercial and public payers. According to the report, spokespeople for CVS Health and CMS said the charges stem from outdated health plan billing codes.

"Some payers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines. If this happens, our pharmacy teams can help patients schedule an appointment for a later date," a CVS spokesperson told CBS

"All of this is temporary," Jen Kates, senior vice president at KFF, told CNN Sept. 20. "It is the first time they’re being commercialized. There are things that have to be put in place, so it is temporary. It is also the case that insurers have known this was going to happen for quite a while."

On Sept. 12, the CDC director delivered the final stamp of approval to XBB.1.5-focused COVID-19 boosters.

Hours before the director's ruling, a CDC committee panel voted 16-0 to recommend the shots for most people 6 months and older. The FDA approved and authorized the new formulas from Pfizer and Moderna on Sept. 11. 

The FDA approved the boosters for people 12 and older, and it gave the new boosters emergency use authorization for those between 6 months and 11 years old. 

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