$40: The Price of Flu Shots While ACIP Stays Empty

A $40 co-pay is the current cost for patients seeking new mRNA flu vaccines in the United States because the federal advisory panel responsible for insurance coverage guidelines is completely vacant. The Advisory Committee on Immunization Practices, or ACIP, has had no members since a court halted changes made by Health and Human Services Secretary Robert F. Kennedy Jr. Kennedy has not nominated new members, leaving the group empty while new vaccines continue to receive approval from the Food and Drug Administration.

The vacancy has created immediate financial and logistical hurdles for consumers. Ron Kroening, a 63-year-old retiree with asthma, recently sought a new flu shot from Moderna that the FDA approved in August for adults 50 and older. His insurance provider denied coverage because the vaccine is not listed in the ACIP catalog. Kroening had to locate a specific pharmacy in his area that stocked the product and pay the full out-of-pocket cost. He noted that while he is satisfied with the vaccine's protection, the lack of coverage is a frustrating barrier.

Insurance coverage rules typically require a year from an ACIP recommendation before plans must cover a new shot by the following January. With the committee empty, this timeline has stalled. A recommendation made in December 2026 would not mandate coverage until January 2028. A recommendation in January 2027 would push that requirement to January 2029. Lindsay Wiley, a law professor at UCLA, described a recommendation next year as the best-case scenario for the new flu vaccine, though she stated there is no reason to expect one soon.

The delay affects other medical decisions beyond flu shots. Some states prohibit pharmacists from administering vaccines without a formal ACIP recommendation. The committee's September 2025 recommendation on respiratory syncytial virus shots was also halted by the court, although many insurers appear to be covering those shots regardless. Additionally, a voided vote to end universal hepatitis B birth doses is now influencing state-level legislation. Medicare coverage for new flu shots for seniors has also faced reported delays, despite legal requirements that do not depend on a committee vote.

The government has appealed the portion of the ruling that disbanded the committee. Aaron Siri, a lawyer who has represented Kennedy, stated 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 to leave the committee empty. She suggested that an inactive panel allows Kennedy to make his own recommendations without the slower pace of his previous appointees.

Industry groups are managing the transition in the interim. The American Health Insurance Plans, which includes Kroening's insurer, has committed to covering all shots recommended as of September 2025. Insurers retain the option to cover new vaccines before they are legally required to do so. Until the committee is reconstituted or a new legal framework is established, patients will continue to face these coverage gaps for newly approved immunizations.