US Flu Shots Cost More as Vaccine Committee Stays Empty

The United States health system relies on a specific advisory group to decide which vaccines are covered by insurance. That group, the Advisory Committee on Immunization Practices, currently has no members. This vacancy has created a gap in policy that is affecting patients and insurers alike.

Health and Human Services Secretary Robert F. Kennedy Jr. replaced the committee's expert members with selected allies earlier this year. A federal judge later stopped those changes, ruling the process was flawed. Kennedy has not nominated new members since the ruling. As a result, the committee cannot issue new recommendations even as the Food and Drug Administration approves new vaccines.

The lack of a recommendation creates financial uncertainty for patients. Ron Kroening, 63, has asthma and seasonal allergies. His doctor suggested Moderna's new mRNA flu vaccine, which the FDA approved for people 50 and older in August. Kroening found a pharmacy with the shot but paid a $40 co-pay. His insurer declined to cover the cost because the vaccine is not on the ACIP list.

Insurers usually have about a year to add a new vaccine to coverage plans after an ACIP recommendation. Without that trigger, the timeline is unclear. Lindsay Wiley, a law professor at UCLA, noted that a recommendation in December 2026 would likely require coverage by January 2028. A recommendation in January 2027 would push coverage to January 2029. Wiley called a recommendation next year the best-case scenario but said there is no guarantee it will happen.

The situation is complicated by other legal and administrative factors. Congress requires insurers to cover new Covid vaccines within 15 days of a recommendation, making them the main exception. Some states also prevent pharmacists from administering vaccines that lack an ACIP recommendation. Additionally, previous decisions by the committee, such as a September 2025 vote on RSV shots, were halted by the court order, though insurers appear to be covering those shots anyway.

The government has appealed the part of the ruling that disbanded the committee. Aaron Siri, a lawyer who represented Kennedy, stated on Monday that the White House and the Department of Justice are not making a serious effort to revive the group. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the federal government is choosing not to install a new ACIP. She suggested that keeping the committee empty allows Kennedy to make his own recommendations without the delay of a formal process.

Reiss warned that trust in the committee's independence has been damaged. She said restoring the group may require a new law to protect its status. The industry group AHIP, which includes Kroening's insurer, has promised to keep covering all shots recommended as of September 2025. Insurers can also choose to cover vaccines before they are legally required to do so.

Kroening said he would still choose the new vaccine and is glad he got it. He is unhappy that his insurance did not pay for it. He described the current state of vaccine policy as a mess.