Moderna flu shot costs patients $40 as federal vaccine panel stays empty

A 63-year-old asthmatic in the United States recently paid a $40 co-pay for a new flu vaccine that his insurance company refused to cover. Ron Kroening sought Moderna’s mRNA flu vaccine, which the Food and Drug Administration approved in August for adults over 50. Trials indicate the shot provides stronger protection than traditional formulations. His insurer declined coverage because the vaccine is not listed on the Advisory Committee on Immunization Practices, or ACIP, list of recommended shots.

The ACIP currently has no voting members. Robert F Kennedy Jr, the Health and Human Services secretary, replaced previous committee experts with handpicked allies, but a judge halted those changes due to procedural errors. Kennedy has not nominated new members since then. Consequently, no new vaccine recommendations are being issued even as the FDA approves new products. Experts warn this uncertainty could persist for years.

Insurance rules typically require companies to cover vaccines within a year of an ACIP recommendation. Without that official nod, insurers have no fixed deadline to add coverage. Lindsay Wiley, a law professor at UCLA, noted that a recommendation in December 2026 would trigger coverage in January 2028. A recommendation in January 2027 would delay coverage until January 2029. Wiley described a recommendation next year as the best-case scenario but said there is no reason to expect one soon.

The gap in federal guidance has created a patchwork of coverage rules across the country. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. Other states are considering laws based on a now-voided vote to end the universal hepatitis B birth dose. Medicare coverage for new flu shots has also faced delays, despite legal requirements that do not depend on an ACIP vote. The only major exception is the coronavirus vaccine, which Congress mandated be covered within 15 days of a recommendation.

The federal government has appealed the court ruling that disbanded the committee. However, Aaron Siri, a lawyer for Kennedy, wrote on Monday that the White House and the Department of Justice are not making a serious attempt to revive the body. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the administration is choosing to leave the committee empty. She suggested the vacancy allows Kennedy to bypass the committee and issue his own recommendations.

Kroening’s insurer belongs to AHIP, an industry group that pledged to continue covering shots recommended as of September 2025. Companies can also choose to cover vaccines before they are legally required to do so. Kroening said he would choose the new vaccine again and is glad he received it. He expressed dissatisfaction that his insurance did not pay for the shot. "It's a mess right now, what they're doing with our vaccines," he said.