Empty Federal Vaccine Panel Forces Patients to Pay $40 for New Flu Shots
With the Advisory Committee on Immunization Practices vacant, insurers lack a clear legal trigger to cover new vaccines, leaving patients to absorb costs until 2028 or 2029.
By David Almasi ·
A 63-year-old asthma patient in the United States paid a $40 co-pay for a new mRNA flu vaccine because his insurer refused to cover it. Ron Kroening received the shot after his doctor recommended Moderna’s new formulation, which the Food and Drug Administration approved in August for adults over 50. His insurance company denied full coverage because the vaccine is not currently listed on the Advisory Committee on Immunization Practices, or ACIP, schedule.
The ACIP is currently empty. Health and Human Services Secretary Robert F. Kennedy Jr. replaced the previous experts with handpicked allies and cut childhood immunization recommendations by one-third. A federal judge subsequently halted those changes, ruling they were procedurally flawed. Kennedy has not nominated new members to fill the vacant seats. Consequently, no new vaccine recommendations are being issued, even as new products receive regulatory approval.
The lack of a recommendation creates a specific financial gap. Insurers generally have one year from an ACIP recommendation to include a vaccine in their plans. A recommendation issued in December 2026 would not require coverage until January 2028. A recommendation in January 2027 would push mandatory coverage to January 2029. Lindsay Wiley, a law professor at UCLA, noted that the legal requirement for coverage does not take effect quickly. She described a recommendation next year as the best-case scenario for the new flu shot, but stated there is no reason to expect one.
Covid vaccines remain an exception due to a Congressional amendment to the Affordable Care Act. That law requires insurers to cover these shots within 15 days of an ACIP recommendation. Other vaccines do not have this timeline. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. This procedural halt also affects other decisions. A September 2025 recommendation regarding new RSV shots was voided by the court order, although insurers appear to be covering those shots regardless.
The delay also impacts Medicare. Reports indicate slow coverage for new flu shots for seniors, even though federal law requires coverage without a specific ACIP recommendation. The government has appealed the portion of the court 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 federal government is choosing to keep the ACIP empty.
Reiss suggested that an empty committee may suit Kennedy, whose previous appointees did not move quickly enough to change the immunization schedule. Bypassing the committee and delaying its reconstitution allows Kennedy to make recommendations independently. She warned that trust in the committee's independence has been undermined. Restoring the panel may require new legislation to protect its status.
Kroening’s insurer is part of the industry group AHIP, which has promised to keep covering all shots recommended as of September 2025. Insurers retain the option to cover vaccines before they are legally required to do so. Kroening said he would choose the new vaccine again and is glad he paid the cost. He expressed frustration that his insurance did not pay for it. "It's a mess right now, what they're doing with our vaccines," he said.
