Patients Face $40 Co-Pays for New Flu Shots as Federal Vaccine Panel Remains Empty

Robert F. Kennedy Jr., the U.S. Secretary of Health and Human Services, has left the Advisory Committee on Immunization Practices without members. The panel is responsible for recommending which vaccines should be covered by insurance plans. Because the committee is currently vacant, insurers have no official guidance on when to add newer shots to their coverage networks. This administrative gap has resulted in immediate out-of-pocket costs for patients seeking recent FDA approvals.

Kennedy’s office initially attempted to reshape the committee by replacing its expert members with allies and cutting childhood immunization recommendations. A federal judge later halted those changes, ruling that the process was flawed. Since that ruling, Kennedy has not nominated new members to fill the seats. The committee has remained empty while new vaccines have continued to receive FDA approval.

The timeline for restoring coverage is now uncertain. Insurers typically have one year from an ACIP recommendation to begin covering a vaccine in their next plan year, which usually starts in January. Because the committee is not meeting, no recommendations are being made. A recommendation issued in December 2026 would not require coverage until January 2028. A recommendation in January 2027 would push the coverage start date to January 2029.

Lindsay Wiley, a law professor at UCLA, noted that the legal requirements for coverage do not take effect quickly. She identified a recommendation next year as the best-case scenario for the new flu shot, but she said there is no reason to expect the committee to convene that soon. The uncertainty contrasts with the rule for COVID-19 vaccines, where Congress amended the Affordable Care Act to mandate coverage within 15 days of an ACIP recommendation.

Ron Kroening, a 63-year-old asthma patient in San Diego County, experienced the cost gap directly this season. His doctor recommended Moderna’s new mRNA flu vaccine, which the FDA approved in August for adults 50 and older. Kroening found that only one local pharmacy stocked the shot. His insurer told him the vaccine was not covered because it was not yet listed by ACIP. He paid a $40 co-pay to receive the injection.

Kroening, a retired public health employee, said that any barrier to vaccination keeps people from getting shots. He stated that he would still choose the new vaccine and was glad he paid, but he was unhappy that his insurance did not cover the cost. He described the current situation as a mess for patients navigating new options.

The vacancy affects more than just flu shots. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. The committee’s previous decisions, including a September 2025 recommendation on new RSV shots, were halted by the court, though insurers appear to be covering those shots anyway. A voided vote to end the universal hepatitis B birth dose is also influencing potential state legislation. Medicare coverage for the new flu shots for seniors has also faced reported delays, even though the law requires it without a specific committee recommendation.

The government has appealed the part of the court ruling that disbanded the committee. However, experts say nothing prevents Kennedy from appointing new members using the correct procedure. Aaron Siri, who served as Kennedy’s lawyer, wrote on Monday that the White House and the Department of Justice are making no serious attempt to revive the committee. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the federal government is choosing not to install a new ACIP.

Reiss suggested that an empty committee may suit Kennedy’s goals, as his previous appointees did not move quickly enough to change the vaccine schedule. Bypassing the ACIP and delaying its reconstitution could allow him to make his own recommendations. She warned that the committee’s future remains shaky even after the court case ends because trust in its independence has been undermined. Restoring the panel may require a new statute to give it legal protection.

Kroening’s insurer belongs to AHIP, an industry group that has vowed to keep covering all shots recommended as of September 2025. Insurers can choose to cover vaccines before they are legally required to do so. Until the committee is reconstituted, patients like Kroening will likely continue to face these temporary out-of-pocket expenses for newly approved vaccines.