Insurers argue that they're not to blame for snags in COVID-19 vaccine rollout

Major payers promised to iron out snags involved in the rollout of the newest COVID-19 vaccine booster when they met this week with Department of Health and Human Services (HHS) Secretary Xavier Becerra.

Some went even further, saying that many of the problems have already been solved or at least are well on their way to being solved. Experts told Fierce Healthcare that some of those snags were unavoidable and illustrated just how tricky handing off such an undertaking from the public to the private sector can be—and, as such, all the blame for these problems should not be laid at the feet of insurers.

Though stakeholders knew insurers would take over the process when the COVID-19 public health emergency ended May 11, the actual deadline turned out to be Sept. 11, when the Food and Drug Administration (FDA) approved the vaccine, which targets the new EG.5 and BA.2.86 COVID variants.

HHS said in a press release that at the meeting this week, participants discussed technical issues that made it difficult for some individuals to get the vaccine and cited reports that pharmacists have told some customers their insurance companies refused to cover the shot.

When the Centers for Medicare & Medicaid Services found out, the agency told plans to fix the problems and reminded them “that they must cover, without cost sharing, any COVID-19 vaccine authorized under an Emergency Use Authorization or approved under a Biologics License Application by the FDA immediately upon the vaccine becoming authorized or approved—a requirement that became binding on September 11, 2023,” an HHS spokesperson told Fierce Healthcare. The American Medical Association updated billing codes for the vaccines on Sept. 18.

Ceci Connolly, president and CEO of the Alliance of Community Health Plans (ACHP), told Fierce Healthcare that “if anybody suggested to you that an insurer is claiming they don’t cover it, that is just not true. It is not the case.”

Ceci Connelly
Ceci Connolly, president and CEO (Alliance of Community Health Plans )

“You may need to go and ask pharmacies why they’re saying that to customers,” Connolly said. “Our member companies are not saying that and they’re not behaving that way. And I want to make sure that’s crystal clear on the record: Our members support the vaccines. They cover them, and they are encouraging people to get the shot.”

The National Association of Chain Drug Stores did not respond to Fierce Healthcare’s request for comment as of publication.

In the HHS announcement, Becerra “expressed his appreciation to insurance providers for taking immediate action to rectify these issues.”

“The group also discussed how providers could help their members to better navigate provider websites and other systems to make it even easier to receive their vaccine,” he said.

Among the more than 20 healthcare industry officials meeting with Becerra were representatives of AHIP, ACHP, the Association for Community Affiliated Plans and the Blue Cross Blue Shield Association. The top brass at major payers such as UnitedHealthcare, Aetna, Humana and Anthem were also present.

In a letter (PDF) dated Wednesday, the organizations stated that “at this time, we understand that systemic technical issues have been largely, if not completely, resolved and are not limiting patient access to vaccines. Should further issues arise, we stand ready to swiftly implement system improvements.”

F. Randy Vogenberg, Ph.D., a principal at the consultancy the Institute for Integrative Healthcare and a member of the board at the think tank the Employer-Provider Interface Council, told Fierce Healthcare the government didn’t “effectively communicate when and how this was going to happen.”

“As an administrator, you can’t do anything unless your client—which in this case is the federal government—tells you to do it and if there’s any mandate associated with getting the vaccine,” he said.

Unlike the original COVID-19 vaccines, the Centers for Disease Control and Prevention recommends, but does not mandate, that individuals get the new version.

Vogenberg described the problem as an operational issue perhaps made a bit more complicated by the fact that drug companies, health plans and pharmacies had to wait until the vaccine was approved Sept. 11.

“It’s all strictly a lag,” said Vogenberg. “And the other issue is a lot of people may not have the insurance policy that they think they have for coverage.”

Connelly said there will always be supply chain issues involving the rollout of any vaccine, and nothing “out of the ordinary” seems to be taking place with the COVID vaccine rollout.

“I’ve been around for enough flu seasons, and sometimes your flu shots are available one week in September and another time it’s not until October, and it’s a different batch. Sometimes your doctor has it,” she said. “Sometimes your pharmacy has it. I don’t think that’s unique to COVID-19.”

Michael Bagel, the associate vice president of public policy at ACHP, told Fierce Healthcare that alliance members have been working not only with HHS but with other stakeholders such as pharmaceutical manufacturers, consumer groups and other insurers to make the rollout as smooth as possible.

“Frankly, compared to the other rollouts initially of this vaccine, or the annual flu vaccine, there have been less issues here and they’ve been remedied immediately,” Bagel said. “When something is raised, it’s addressed oftentimes the same day, with the No. 1 goal of making sure that every consumer who wants the vaccine can get one.”

Connelly said her member plans focus mostly on community outreach for what she considers an important preventive health measure.

“They work with all sorts of community partners,” Connelly said. “They are investing a lot of their own resources into getting people vaccinated. And so that’s why I get a little concerned if somebody suggests that our health plans are not 100% supporting and covering these important vaccines.”