The new Covid vaccine rollout seems to be chaotic, as were past rollouts, with people unable to make appointments at busy pharmacies, or unable to get insurance payments.
Reports from around the nation in the first week since approval say that insurers have not made payment procedures clear, and that people are showing up for appointments and being turned away because the supply of vaccine is gone. Pharmacy employees tell of running out of vaccines because demand is so high.
“A viewer told us her pharmacy turned her down because Medicare would not cover her vaccine. System readiness for the new shots may be to blame,” WUSA-9 in Washington, D.C., tweeted on Tuesday.
“Hey United AARP Medicare Advantage, when are going to approve the new Pfizer Covid vaccine? I’m at CVS ready to get jabbed but y’all won’t pay for it. Would you rather us old folks get sick????” Molly Rodgers tweeted earlier.
‘We went to CVS and asked for the updated Covid shot. We had to pay $190.99 for each person as they said our insurance @SelectHealth does not cover it,” Traci Tabish Dickey tweeted on Sept. 20.
“I tried and failed to get a COVID vaccine yesterday. None of my HMO’s in-network pharmacies have the booster in stock yet. So, I tried to go to an out-of-network pharmacy. I knew this might mean paying $200. I’m going to be traveling next week, so I was willing to pay, but…” Cynthia Cox tweeted. “Walgreens (the out-of-network pharmacy) is apparently not set up to accept cash payments for vaccines. Even though they understood I was willing to pay out-of-pocket, they have to go through my insurance. The helpful pharmacy tech spent an hour on the phone with my HMO trying.”
‘Grievance with Humana’
“As of yesterday Humana Medicare didn’t have the new Covid vaccine in their system. I was unable to get it . It won’t be fixed until next week. I filed a grievance with Humana,” Kathy Williams tweeted on Tuesday — and then later she said the problem had been resolved.
Last week, The Albany Times-Union reported: “By Thursday, many consumers in the Capital Region reported receiving calls from their pharmacists advising them to reschedule or risk paying $200 out-of-pocket for the immunizations. A representative for CVS, which declined to make a pharmacist available for an interview, said some insurers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines.”
As of Sept. 15, Centers for Disease Control guidance recommended the updated (2023–2024 Formula) mRNA COVID-19 vaccine for everyone 5 years old and older. This new vaccine is supposed to be more protective than the bivalent one that was recommended in the spring.
Detailed guidelines by age, by other criteria (immunocompromised or not? previous allergic reactions or not? MIS-C or MIS-A? history of myocarditis or pericarditis?) are on this C.D.C. page.
The page also discusses not only the MRNA vaccines made by Moderna and Pfizer, but also the Novavax protein subunit vaccine.
CVS employee: Demand ‘crazy’
While some of the Medicare and other insurance billing problems appear to have been resolved by Wednesday, Sept. 20, on the Reddit subreddit r/CVS, employees had a lot to say in the last few days about problems.
“Some stores are selling out that quickly. One store in my area was at one point 70 vaccines in the hole. Demand for this one is crazy compared to the other recent boosters.”
“Its true we received vaccine on Thursday started on Friday morning nd finished on Sunday night almost 50 to 60 appointments only covid vaccine”
“At least for Pfizer, a bunch of insurances, Medicare and Medicaid included are not covering it yet. Either they need to do an update for the product on their end, or there’s a LOT of debate about how much the reimbursement to the pharmacy should be as it’s now a commercial product that’s got a list price of almost $200 instead of fully funded by the government (outside of the administration fee that the pharmacy billed and collected).”
“We’re having a lot of billing issues over on the West Coast!”
‘Absolute hell’
Walgreen’s subreddit also had a lot of opinions.
“3 times, and for 3 different situations, i’ve had to stop myself from leaving the pharmacy and abandoning my coworkers during the absolute hell this new vaccine season has already become on the first day, especially with the drop of the new COVID vaccine.”
“When I was good I had to do COVID/flu testing, no exceptions, but no enforcing masks and we get no face shields or hazard pay. I can’t opt out either, despite the fact that I have medical documentation that I am at higher risk. So I said f*** it. This s*** hole does not pay enough for this level of stress.”
“i’m not going to be the first or last one to complain about the influx of vaccine appointments we have gotten but holy hell… day one of having the covid vaccine and we were so busy it was unbearable… we used to be a store that ALWAYS accepted walkins and this time around we are being strict about making appointments due to the high amount of flu/covid vaccines being scheduled (one every 15 minutes!!!!) and we are facing a high amount of backlash for not accepting walk-ins despite the explanation on why we are appointment only at this time 🥲… I came in at 10am today and my poor coworkers were running around like chickens with their heads cut off because of the high volume of vaccines that were scheduled… the opener hadn’t even filled a single prescription since she came in because of how busy we were with vaccines… it makes me wish that vaccines were to be scheduled 30 minutes apart rather than 15 minutes. lord i hope tomorrow is better than the shit show that was today.”
“my store gets 2 appointments every 15 min, today was such a sh!thole, couldnt get anything done other than trying to bill vaccines, which half the insurances dont even have the vaccine as formulary yet”
‘We ran out’
“I had trouble with all Amazon insurance Plus we had 2 appointments every 15 minutes and it was just me and the pharmacist It was crazy I billed and gave all the vaccines then we ran out of covid vaccine”
“Omg I came in at 10;30 yesterday and walking down the isle, I heard a roar from the pharmacy area. It was like a convention. People were getting 4 shots at a time in one appointment.”
“I closed last night after 80 appts all quadruple booked. “
“We are scheduled every 10 minutes. All techs are new except me. We are drowning. I am terrified that someone is going to make an error that isn’t caught and causes harm. This is so dangerous, we need the company to do a max of 3 per hour. Not 4 shots every 10 minutes”
“This is my first flu season in pharmacy. My location hasn’t received the new COVID vax yet. We were able to borrow 40 doses from another store for Monday, gone. We called every patient scheduled and turned off scheduling for the next few days regarding COVID. I now have undeniable proof that people don’t check their messages, but it’s our fault that they still showed up for a cancelled appointment.”
“Covid-19 vaccine manufacturers, which charged the federal government about $29 per dose for the last vaccine booster, are now billing pharmacists 3-4 times that amount on the commercial market, according to research from Kaiser Family Foundation,” The Times-Union added.
What you can do
If you are asked to pay for a vaccine, there are things you can do.
First, private insurance companies are required to pay for vaccines with no copay. But, unlike last year, insurers don’t have to pay out-of-network providers. So if you are going to an out-of-network place, and they ask you to pay, find an in-network one — your doctor’s office, for example, or an in-network pharmacy.
CVS, Walgreens and eTrueNorth are required by federal law to cover your vaccine at no cost. The new Bridge Program insures that. “There are 25-30 million adults without health insurance and additional adults whose insurance does not cover all COVID-19 vaccine costs. CDC’s Bridge Access Program provides no-cost COVID-19 vaccines for these adults,” the program’s page on the Centers for Disease Control website says.
“You can get no-cost COVID-19 vaccines at healthcare providers, federally supported health centers, and retail pharmacy chains participating in the Bridge Access Program,” the page says. “Visit vaccines.gov to find providers that offer no-cost COVID-19 vaccines through the Bridge Access Program. Providers participating in the Bridge Access Program are contractually obligated to add vaccine availability to vaccines.gov. We expect reported availability to increase in the coming days.”
Among the Bridge Access providers: State and local health departments; and state and local immunization programs are working with Health Resource and Services Administration-Supported Health Centers to provide no-cost COVID-19 vaccines.
For the big chains, C.D.C. is contracting with CVS, Walgreens, and eTrueNorth through existing Increasing Community Access to Testing (ICATT) contracts.
For uninsured or underinsured children, the Vaccines for Children program should cover not only Covid vaccines, but all required vaccines. This covers children meeting any one of these requirements: Medicaid-eligible, underinsured, uninsured, or American Indian or Alaska native. Underinsured children — those whose insurance policies do not cover any vaccines, or do not cover recommended vaccines — are eligible to receive vaccines only at federally qualified health centers (FQHCs) or rural health clinics. For more detail, check this page.
For more details on what you can do, here’s a fuller post.
