A judge halted changes to the panel, and the US health secretary has not nominated new members. One patient says he paid a $40 co-pay for a new flu shot; a future recommendation would start the usual coverage timetable.
A court order has halted changes to the US vaccine advisory panel, and Health Secretary Robert F Kennedy Jr has not nominated new members. The panel, called the Advisory Committee on Immunization Practices (ACIP), is not making new recommendations. That matters because approval of a vaccine does not, by itself, start the usual deadline for insurers to cover it.
The US Food and Drug Administration approved Moderna’s new mRNA flu vaccine in August for people aged 50 and older. Ron Kroening, 63, told the Guardian that he found only one nearby pharmacy stocking it and paid a $40 co-pay. He said his insurer attributed the charge to the absence of an ACIP recommendation. Insurers commonly have time to add a newly approved shot, however, so a first-year co-pay alone does not show that the interruption to recommendations caused a loss of coverage.
ACIP recommends who should receive a vaccine after the regulator approves it. Under the usual rule, insurers have a year after that recommendation to add coverage by the next applicable plan year, which normally starts in January. The timing of a recommendation can therefore change the coverage deadline substantially:
| If ACIP recommends a vaccine | Insurers must cover it by |
|---|---|
| December 2026 | January 2028 |
| January 2027 |
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UCLA Law professor Lindsay Wiley said a recommendation for the new flu shot might come next year, but there is no assurance that it will. January 2029 is therefore a possible coverage deadline if ACIP recommends the shot in January 2027, not a confirmed date for either action. Insurers can choose to cover vaccines sooner. AHIP, an insurance industry group, has pledged to continue covering shots recommended as of September 2025.
In some states, pharmacists cannot give a vaccine without an ACIP recommendation, regardless of whether an insurer will pay for it. Other coverage rules also differ: federal law requires coverage of new flu shots for seniors under Medicare even without a panel recommendation, although the Guardian described delays in insurers providing that coverage. For Covid vaccines, an amendment to the Affordable Care Act instead requires coverage within 15 days of an ACIP recommendation.
The US government has appealed the part of the judge’s order that disbanded the committee. Experts said Kennedy could follow the proper process to appoint new members without waiting for the appeal. Until ACIP makes another recommendation, the usual insurer-coverage deadline for the new flu shot remains unset.
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