A new flu shot, a $40 co-pay

When the FDA gave Moderna's mRNA flu vaccine approval in August for people aged 50 and up, trials suggested it would protect better than traditional flu shots. Ron Kroening, 63, wanted it: his doctor recommended the shot because he has asthma and bad allergies this time of year. He came away charged a $40 co-pay.

His insurer had a simple answer when he asked why. "The reason the mRNA isn't covered is because it's not listed as an ACIP vaccine," the company told him.

Kroening spent his career on this side of the problem - he is a retired public health employee who worked on immunizations at the state level in Oklahoma. He says he would still choose the new vaccine despite the co-pay. But getting it, and getting it paid for, has become a different matter. "It's a mess right now, what they're doing with our vaccines," he said.

The stalled committee behind the rule

Vaccine insurance coverage requirements hinge on the Advisory Committee on Immunization Practices. Under the federal coverage rule, if ACIP recommends a vaccine in December 2026, insurers must cover it by January 2028; a recommendation in January 2027 pushes that deadline to January 2029. If the committee makes no recommendation by the end of this year, insurers cannot be required to cover the Moderna flu shot until January 2029 at the earliest.

Even under normal conditions, the mechanism moves slowly. Insurers usually get at least a year after FDA approval to add a new vaccine, so first-year co-pays are not unusual. Lindsay Wiley, professor of law and faculty director of the Health Law and Policy Program at UCLA Law, explained that the legal mandate only arrives after a drawn-out process rather than taking effect right away.

The rfk jr vaccine policy changes, though, broke the machinery that produces recommendations:

• He cut childhood immunization recommendations by a third and replaced ACIP's members with his own allies.
• A judge's order halted those changes because they were not done correctly.
• Kennedy has not nominated any new ACIP members, so the committee is producing no new vaccination recommendations.

"It seems likely that at best we would get a recommendation next year," Wiley said - but there is no reason, she added, to think the committee will actually do so. Covid vaccines are the one exception to this coverage law: Congress amended the Affordable Care Act to require coverage of Covid immunizations within 15 days of an ACIP recommendation.

Ripples beyond the flu shot

• Some states will not allow pharmacists to give vaccines without an ACIP recommendation.
• Decisions made before the committee was disbanded were also halted, including the September 2025 recommendation on new RSV shots - though insurers appear to be covering them anyway.
• A now-voided vote to end the universal birth dose of the hepatitis B vaccine is still influencing potential state-level laws.
• Delays have been reported for insurers covering the new flu shots for seniors under Medicare, which is mandated by law even without an ACIP recommendation.

Appeal, and a committee in doubt

The US government has appealed the part of the judge's order that disbanded the vaccines committee. Aaron Siri, who has served as Kennedy's lawyer and litigated against vaccine makers, wrote on Monday that the White House and DOJ are making no serious attempt to revive the committee. "It appears the DOJ and the White House are doing everything they can to make sure that there is no functioning vaccine committee," he wrote.

Dorit Reiss, a vaccines expert at UC Law San Francisco, put it more bluntly: "The federal government is choosing not to put in place a new ACIP." In her view, Kennedy has aggressively undermined trust in the independence of the committee, and without dramatic changes it is probably not coming back the way it was. Bringing it back, she said, would require a statute giving it some protection, because the episode showed how politically vulnerable the committee is.

There is a partial safety net. Kroening's insurer is a member of AHIP, the insurance industry group that has vowed to continue covering all shots recommended as of September 2025. For the new Moderna flu shot, approved after that date, the formal requirement remains years away - with no recommendation and no functioning committee to deliver one. The US government has appealed the part of the order that disbanded the committee, while Siri wrote Monday that the White House and DOJ are making no serious attempt to revive it.