These NC insurers might not cover your COVID vaccine. How much will it cost?

With the announcement of new restrictions on who can get COVID-19 vaccines, at least one North Carolina insurer is revaluating its plan to its cover costs.

The U.S. Food and Drug Administration last week revoked emergency authorization for COVID-19 vaccines, limiting shots to people 65 and older and younger adults with at least one underlying condition, The Associated Press reported.

Children’s access was also narrowed. Pfizer’s vaccine is no longer authorized for those under 5, while Moderna’s Spikevax remains available only to children under 5 with serious health issues.

As a result, many pharmacies in the state are making appointments unavailable for North Carolina residents, citing state and federal regulations, The Charlotte Observer reported.

And one insurer in the state that provides services to more than 4 million North Carolinians could decide to drop the vaccine from its coverage plans, leaving patients to foot the bill.

Here’s what you need to know.

Will insurance continue to cover COVID-19 vaccine costs?

Possibly.

Blue Cross NC, the largest health insurance provider in the state, plans to “carefully review final federal recommendations from the Centers for Disease Control and the Advisory Committee on Immunization Practices (ACIP) when they are available,” spokesperson Sara Lang told the Observer in an email.

ACIP, the CDC’s vaccine advisory panel, is set to meet Sept. 18-19. The committee may discuss and vote on updates to COVID-19 vaccine recommendations, which could allow North Carolina pharmacists to administer the shot without a prescription. But there’s no guarantee, so state restrictions might remain in place.

Aetna spokesperson Phil Blando told the Observer that the company “continues to provide coverage for approved vaccines, including COVID-19, in compliance with applicable state and federal cost-sharing requirements. All members of insured plans voluntarily choosing to vaccinate against COVID-19 may do so with no cost sharing.”

United Healthcare, Cigna and Humana did not respond to requests for comment from the Observer at the time of publication.

Why is the ACIP decision important?

The ACIP’s upcoming meeting could directly affect whether insurers continue covering COVID-19 vaccines, Dr. David Wohl, an infectious disease specialist at UNC Health, previosuly told the Observer.

“Insurers today have been obligated to cover what the CDC Advisory Council recommends,” he explained. “If they don’t recommend the vaccines for many people, insurers have the prerogative of not covering it.”

While some insurers with pharmacy networks might still cover the shots, Wohl noted that many of the newly appointed council members are considered “vaccine hesitant,” raising the possibility that future guidance could make it easier for insurers to restrict coverage.

“That’s going to really throw this into an uncharted territory,” said Wohl.

How much will vaccines cost if insurance doesn’t cover them?

Without insurance, the shots could cost upwards of $140, according to the CDC’s vaccine price list – and at least one national pharmacy chain is charging even more.

Those without insurance wanting a shot at CVS will have to pay $224.99, according to its website.

Walgreens and Walmart did not respond to requests from the Observer for vaccine pricing information by the time of publication.

Are there any NC programs that can help with vaccine costs?

Yes, but there may be limited options.

Local health departments often offer free or low-cost vaccine options. However, when the Observer inquired about appointments for a COVID-19 vaccine with the Mecklenburg County Health Department on Wednesday, we were told vaccine shipments would not arrive until the end of the month.

And according to spokesperson Leah Holdren, the Wake County Health Department is offering Moderna’s Spikevax for those 65 and older and for those between the ages of 6 months and 64 years old with “at least one high-risk condition.”

However, according to state law, COVID-19 vaccines can only be administered to those over 18 with a valid prescription.

Evan Moore

The Charlotte Observer

Evan Moore is a service journalism reporter for the Charlotte Observer. He grew up in Denver, North Carolina, where he previously worked as a reporter for the Denver Citizen, and is a UNC Charlotte graduate.