“If a patient attests to having one of these conditions or situations that places you at higher risk of severe illness from COVID-19, they are eligible for the vaccine under current FDA guidelines,” says Amy Thibault, a CVS Health spokesperson.
Yet confusion remains. For example, the American College of Obstetricians and Gynecologists considers pregnancy a high-risk condition that increases the odds of COVID-19 complications, but last spring Health and Human Services Secretary (HHS) Robert F. Kennedy Jr. announced the removal of pregnant women from the vaccine recommendation list.
Kennedy also removed healthy children from the list, including those ages 6 to 23 months, whom the American Academy of Pediatrics (AAP) considers to be at high risk for COVID-19 complications. The AAP strongly recommends that all children in this age group get the updated shot, including those who live in a household with someone who is at high risk.
Most American Adults Qualify for a Vaccine Under the New Guidelines
If you want a COVID vaccine and you don’t think you have any of the above conditions, you may still qualify due to a condition or situation that puts you at higher risk, says Thibault. “Consult your pharmacist or medical provider if you need help,” she says.
And if that still doesn’t work, it’s likely that you can find a healthcare professional who can write a prescription anyway, says David Wohl, MD, an infectious disease doctor and professor of medicine at UNC Health in Chapel Hill, North Carolina.
“Most clinicians totally understand the benefits of the updated COVID-19 vaccines and are eager to help. This does place a tremendous burden on clinics that are fielding calls and issuing prescriptions,” says Dr. Wohl.
Pharmacies in Different States Have Different Rules
Pharmacies administer the vast majority of COVID vaccines in the United States. But pharmacy rules are state-specific, and not all states allow pharmacists to give shots outside of CDC recommendations without a prescription.
That’s why some pharmacies currently require prescriptions for people under 65, while others allow self-attestation of a high-risk condition (meaning you say you have a qualifying condition, and the pharmacist takes your word for it).
CVS pharmacies can administer COVID-19 vaccines without a prescription in 40 states, says Thibault, excluding:
- Arizona
- District of Columbia
- Florida
- Georgia
- Louisiana
- Maine
- North Carolina
- Oregon
- Utah
- Virginia
- West Virginia
“Once ACIP acts on the updated COVID-19 vaccines, or states take additional action to authorize pharmacy dispensing prior to ACIP recommendations, we’ll be able to offer the FDA-approved COVID-19 vaccines without a prescription in the remaining states,” says Thibault.
However, confusion about the vaccines means that even people who should clearly qualify for the COVID-19 vaccine without a prescription, like seniors, may face roadblocks. “Even people who are considered by the more restrictive approval of the vaccines to qualify are being told by pharmacies to get a doctor’s prescription,” says Wohl, who practices in North Carolina.
“Last night I was texted about two people in their seventies who were turned away from a local pharmacy for this reason,” he says.
Want to Get the Vaccine at Your Pharmacy? Check First
To get vaccinated for COVID-19, check with your pharmacy beforehand to see what they require, says Wohl. “If you only have to attest that you are eligible, then go. But if they require a prescription, contact your clinician, who can send an electronic prescription or just have you come into the clinic to get the shot,” he says.
For people without a regular doctor, local health departments may be the best bet. Many still run vaccine clinics and, in some cases, offer transportation for those who need it.
Will Insurance Cover the Latest COVID Shots?
This year’s insurance coverage is murkier than in past rollouts. Insurers generally follow CDC vaccine committee recommendations, and those haven’t been finalized yet. In the meantime, some plans may cover the vaccine, some may require a copay, and others may not cover the shot at all.
“Our understanding is that the COVID-19 vaccine is covered by most insurance plans at no cost for eligible patients. Patients should check with their insurer to determine whether the updated COVID-19 vaccine is covered by their individual health plan,” says Thibault.
“Individual health plans and plan sponsors will be prepared to make coverage decisions informed by science, the latest medical evidence, and data. This process will be evidence-based, evaluate multiple sources of data, including but not limited to ACIP, and will be informed by customer needs,” said Stow.
“Call your pharmacy ahead of time and ask if you should expect a copay for the COVID vaccine. If your usual pharmacy isn’t sure or tells you that you’ll be charged, you can try another pharmacy to see if they are using a different policy,” says Caitlin Donovan, senior director at the Patient Advocate Foundation, a nonprofit that provides healthcare case management services and financial aid.
Help paying for shot is available through the following resources:
- PfizerRxPathways.com offers assistance for eligible uninsured adults.
- Moderna partners with Project HOPE and Direct Relief to distribute free shots through community health centers.
- The Patient Advocate Foundation provides co-pay relief for eligible families.
- Local health departments may still provide free or low-cost options.
Bottom Line: How to Get a COVID-19 Vaccine
Getting vaccinated this year may take persistence. Here’s how to make it easier:
- Call more than one pharmacy to compare requirements and availability.
- Check your state health department website for local clinics and eligibility updates.
- Ask your doctor about prescriptions if needed.
- Call your insurance company to inquire about coverage beforehand, and bring your insurance card and a list of medications or diagnoses with you to the pharmacy.
When Is the Best Time to Get a COVID-19 Shot?
Both Wohl and Thibault agree that getting a COVID-19 vaccine now is a good idea — if you can get one.
“Wastewater shows a surge in SARS-CoV-2 [the virus that causes COVID-19 infection] in the water. Many people are getting sick,” says Wohl.
Wastewater testing looks for pieces of the COVID-19 virus in sewage, which people shed when they use the bathroom. By tracking whether those levels go up or down, public health officials can spot illness trends in the community, often before case counts rise.
Wohl says there’s also a chance that the ACIP, which has recently gone through significant member turnover, may whittle down the list of conditions that qualify for the COVID-19 vaccines for people under 65, he says.
Get it while you can, says Thibault. “It is hard to time this just right. I generally favor October, so that my antibody levels are higher during the holidays. But I am concerned access to these vaccines will become more restricted,” she says.
Why Vaccination Still Matters
Most people who wound up in the hospital because of COVID-19 had not received the updated vaccine.
Great Job Becky Upham & the Team @ google-discover Source link for sharing this story.
