COVID-19 Vaccines

Sonya Collins

Until this fall, COVID-19 vaccines have been free for everyone in the United States regardless of insurance, finances, or immigration status. But HHS has now phased out that program, and COVID-19 vaccines have transitioned to the commercial market. While CDC’s Bridge Access Program makes free vaccines available to uninsured and underinsured adults through various pathways, critics have concerns about barriers to access.

“We had finally crossed the bridge of people in underserved communities being uneasy about getting the vaccine. Now we’re in a place where they just can’t find it,” said Jacinda Abdul-Mutakabbir, PharmD, assistant professor of clinical pharmacy at the San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California. “Vaccine hesitancy, we could work on that. But no access? That’s a major limiting factor.”

COVID-19 vaccines still free… for most

Now that the COVID-19 public health emergency has ended, COVID-19 vaccines are no longer free for everyone. However, they are still free for most people. Medicare, Medicaid, and ACA-compliant commercial health insurance will cover the vaccine for adults. Children will continue to receive the vaccine free of charge through commercial insurance, the Vaccines for Children Program, and the Children’s Health Insurance Program, according to HHS’ Administration for Strategic Preparedness and Response.

The estimated 25 to 30 million U.S. adults who are uninsured, or those whose health insurance does not cover the vaccine, such as pre-ACA grandfathered plans and short-term limited-duration insurance plans, can get free COVID-19 vaccines at federally qualified health centers; state, local, tribal, or territorial health departments; and pharmacies participating in CDC’s Bridge Access Program, which include CVS, Walgreens, and eTrueNorth pharmacies. Uninsured adults who get free vaccines might be charged an administration fee.

Foreseeable gaps in access

The Bridge Access Program leaves it up to participating pharmacies to verify patients’ eligibility to receive a free COVID-19 vaccine. The onus is also on these pharmacies to make potential beneficiaries aware of the program. Among the program participation requirements outlined by HHS is to conduct outreach to underserved communities and others who may be eligible. Underserved patients’ access to vaccines depends on pharmacies’ capacity to create widespread awareness of the program.

It’s clear, said Abdul-Mutakabbir, that so far, uninsured and underinsured patients do not know where they can get updated COVID-19 vaccines.

“When we do vaccine clinics, we have people coming from 30, 40, or even 50 miles away because they don’t know where else they can go to receive the vaccines,” she said. These community-based pop-up clinics, supplied with vaccines provided by the government, will now become fewer and further between, she added.

This underscores concerns that when under-resourced patients are no longer able to get COVID-19 vaccines where they were accustomed to getting them in the past, such as churches and community centers, they may stop getting them altogether.

Many people, if they are motivated to do so, may have to travel much further than 50 miles to get COVID-19 vaccines for themselves and their families. Some 59 million Americans live in pharmacy deserts. Others may live in rural areas where the lone independent pharmacy is not contracted with CDC’s Bridge program.

Many of those whose only means of obtaining an updated COVID-19 vaccine is through cash-pay won’t be able to afford this option.

“It’s just the unfortunate circumstance that we are in, and it’s one where we are going to continue to see this gap that is just going to keep widening,” Abdul-Mutakabbir said. “In my opinion, we’re taking three steps back in terms of vaccine access.”

The Biden administration appealed to the manufacturers to price the vaccines reasonably and affordably, but it has not offered any incentive to do so. According to Health Affairs, the government invested nearly $32 billion in mRNA vaccine research, development, and procurement, much of which went to buying the vaccine from the drugmakers at $15.25 to $30.48 per dose, depending on the manufacturer and the iteration. The drugmakers have set the commercial prices at up to more than four times those original prices at $110 to $130 per dose.

“We are a revenue-based health care system,” Abdul-Mutakabbir said. “Our best hope is if the companies themselves would take some responsibility for addressing these gaps because they are the ones who determine the price.” ■