Coloradans can get updated COVID vaccines, but insurance might not cover the shots

Anyone months and older who wants a COVID- shot in Colorado can now get one but the vaccine will only be free for those with the right insurance at least for now Initially pharmacies couldn t administer the updated shots in Colorado unless a client had a prescription The state allows pharmacists to administer vaccines recommended by the Centers for Complaint Control and Prevention s advisory committee but not other shots Dr Ned Calonge chief biological officer for the state healthcare department responded by issuing a standing order essentially a prescription for every resident allowing them to get vaccinated at retail pharmacies But that order doesn t guarantee insurance will cover the shots or that pharmacies will choose to stock them Last year fewer than half of people over nationwide received an updated COVID- shot with uptake dropping further in younger age groups raising questions about whether soundness care providers will believe demand is high enough to justify buying the vaccine The standing order provides accessibility It doesn t necessarily provide availability Calonge mentioned Tuesday The Colorado Division of Insurance issued a draft rule last week that would require state-regulated plans to cover COVID- vaccines without out-of-pocket costs for people of any age assuming the division passes it as written Insurance cards from state-regulated plans typically have CO-DOI printed in the lower left corner The state s rule doesn t apply to federally regulated plans which account for about of employer-sponsored insurance plans in Colorado Calonge noted Typically however those plans try to offer competitive benefits since they mostly serve large employers he declared My hope would be they would want to keep up with other insurers he revealed This isn t the first time that people on state-regulated plans have had benefits not guaranteed for people with federally regulated insurance Colorado capped the cost of insulin and epinephrine shots to treat severe allergic reactions in state plans but couldn t require the same for plans the state doesn t oversee In those cases it offered an affordability venture requiring manufacturers to supply the medication at a lower cost for people who aren t covered by the state caps Medicare or Medicaid At least two Colorado insurers surveyed by The Denver Post mentioned all of their plans will cover COVID- vaccines while others hedged Select Fitness which sells Medicare and individual marketplace plans in Colorado explained its plans in the present cover COVID- vaccines without out-of-pocket costs for everyone Kaiser Permanente Colorado explained in a message to members that it will pay for the shot for anyone months or older Donna Lynne CEO of Denver Medical stated the physical condition system s insurance arm is waiting on clarification about when it should cover the vaccines Denver Physical condition Medicinal Plan offers multiple plan types specific state-regulated and specific under federal rules she announced It s less of a decision on our part than understanding what the vitality department and the insurance department are saying she explained You can t have one insurance company saying they are doing it and one saying they aren t doing it Anthem revealed it considers immunizations medically necessary if the American Academy of Pediatrics American Academy of Family Physicians or the CDC s vaccine advisory committee has recommended them but didn t specify whether it would charge out-of-pocket costs for medically necessary vaccines If those bodies stated that certain people could get a particular vaccine but not that they should Anthem would decide about coverage on an individual basis its website announced The other groups have recommended the shots for people over or under with the option for healthy children in between to get a booster if their parents wish The state s Medicaid activity is still waiting for guidance from federal government about whose vaccines it can cover according to the Colorado Department of Robustness Care Framework and Financing and Medicare isn t yet paying for the shots For majority of the COVID- vaccines relatively brief existence they were free and recommended for everyone months and older In the federal cabinet stopped paying for them which meant uninsured people no longer could be sure they could get the shot without paying Almost all insurance plans still were required to pay for the shots though because the CDC s Advisory Committee on Immunization Practices recommended them In previous years the committee recommended updated shots within days of the U S Food and Drug Administration approving them In late August the FDA approved the updated vaccines for people over and those with one of about conditions increasing their hazard of severe infection including asthma obesity and diabetes Doctors still could prescribe the vaccine off-label to healthy people in the same way that they prescribe adult medications for children when an alternative specifically approved for kids isn t available This year however the committee won t meet until Thursday and may not recommend the shots when it does Secretary of Vitality and Human Services Robert F Kennedy Jr dismissed all of the committee s members earlier this year and replaced them with new appointees most of of whom oppose COVID- vaccines Related Articles Colorado issues order allowing pharmacies to provide COVID vaccines without prescription CVS Walgreens now require prescriptions for COVID vaccines in Colorado No changes to routine vaccines but pregnant women might have to pay for COVID shots The committee s decision also will determine whether the Vaccines for Children venture can supply the shots for children who are uninsured covered by Medicaid or are members of American Indian tribes Calonge stated If the committee decides not to recommend the vaccines those children likely won t have another option to get the shots he reported When states and the federal authorities passed laws linking coverage to the committee s recommendations they did so expecting that it would also remain an apolitical arbiter of the evidence for vaccinating the population or specific subgroups disclosed Cathy Bradley dean of the Colorado School of Society Robustness Now that premise is in doubt and states are looking for other avenues to ensure access she declared Allowing anyone who wants a COVID- vaccine to get one from the provider of their choice is an central first step for Colorado because the vaccines remain effective in preventing severe illness Bradley revealed As the situation develops the state will likely need to come up with other partial solutions to preserve access she disclosed It s a different path for everyone depending on what your coverage is she revealed Sign up for our weekly newsletter to get physical condition news sent straight to your inbox