Patients Pay $40 for New Flu Shots as Federal Panel Stays Empty

Ron Kroening paid a $40 co-pay for a new mRNA flu vaccine in late 2026 because his insurance company did not cover the shot. The 63-year-old asthma patient was advised to use Moderna’s product, which the Food and Drug Administration approved in August for adults 50 and older. His insurer, part of the industry group AHIP, stated the vaccine was not covered because it lacks a listing from the Advisory Committee on Immunization Practices, or ACIP. Kroening noted that while he is glad to have the stronger protection, the out-of-pocket cost was unexpected.

The cost gap stems from a vacancy at ACIP, the federal body that guides which vaccines insurers must cover. HHS Secretary Robert F. Kennedy Jr. replaced the committee’s members with handpicked allies earlier in 2026, but a federal judge halted those changes, finding the process was flawed. Kennedy has not nominated new members since the ruling, leaving the panel empty. Without a functional committee, no new vaccine recommendations are being issued, even as manufacturers win FDA approval for new products.

For most vaccines, insurers typically have one year from an ACIP recommendation to add coverage by the next plan year, which usually begins in January. A recommendation issued in December 2026 would not require coverage until January 2028. A recommendation in January 2027 would push the deadline to January 2029. Lindsay Wiley, a law professor at UCLA, said the legal requirement for coverage does not take effect quickly. She called a recommendation next year the best-case scenario for the new flu shot but said there is no reason to expect one soon.

The delay creates uncertainty beyond flu shots. Some states bar pharmacists from administering vaccines without an ACIP recommendation. Previous decisions, including a September 2025 recommendation on RSV shots, were also halted, though insurers appear to be covering those products anyway. Medicare coverage for the new flu shots for seniors has also faced reported delays, despite laws requiring it without a formal recommendation.

The government has appealed the part of the ruling that disbanded the committee. Aaron Siri, a lawyer for 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 not to install a new ACIP. Reiss said an empty committee may suit Kennedy, whose previous appointees did not move fast enough to change the schedule. Bypassing ACIP could allow him to make his own recommendations.

Reiss warned that the committee’s future is shaky even after the court case ends because trust in its independence has been undermined. She said restoring it may require a statute giving it protection. Kroening’s insurer has vowed to keep covering all shots recommended as of September 2025, but patients facing new products are left to navigate the gap. Kroening said he would still pick the new vaccine and is glad he paid, but is unhappy that insurance did not cover it. "It's a mess right now, what they're doing with our vaccines," he said.