While the COVID-19 public health emergency finally ended earlier this year, that doesn't mean the virus itself is gone for good. In fact, late last week, new COVID vaccines from Pfizer and Moderna were rolled out, with guidance from the Centers for Disease Control (CDC) advising everyone six months and older to get the updated booster. Per its Sept. 12 press release, the CDC also noted that most Americans should be entitled to a free vaccine—with different options depending on whether you have health insurance. However, this wasn't the case for some folks, who ended up facing a large bill. Read on to find out why some pharmacies are charging almost $200 for the latest COVID-19 booster.
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People were shocked when they saw the price of the COVID booster.
Ken Wolter / ShutterstockSeveral people have taken to social media to voice frustrations with their vaccine bills at major pharmacies, with prices ranging from $125 to $190, CBS News Boston reported. Some said they noticed signs for free vaccines, but later found out that wasn't the case.
"Went to get mine at CVS today and while signs were everywhere in pharmacy saying 'Free Covid-19 vaccines' they said I would have to pay $190—even tho I’m on Medicare. What’s up with that? Decided to wait to see if they get this sorted out."
The issue isn't limited to Medicare subscribers, as others cited issues with several other insurance carriers, including Cigna and Blue Cross Blue Shield, CNN reported.
"My insurance—@HorizonBCBSNS—is somehow delayed in covering the new Covid vaccine," a subscriber wrote on X. "Have to pay the $190 out of pocket. I’m fortunate I can afford to do this but like…what? Why is this a thing?"
Yet another wrote, "@Walgreens your own website says the covid vaccine is free, yet my partner was charged for it. Why is that?"
There's an issue with billing for the new vaccine.
iStockIn general, the COVID-19 vaccine has been free for most. If you have health insurance, the Affordable Care Act requires almost all plans to cover the vaccines. Those who aren't insured are still supposed to be able to get a free vaccine at Walgreens, CVS, local health departments, and federally qualified centers, CNN reported.
But while some people were told they'd have to pay out of pocket to get their shot, both government agencies and private insurance plans say the issue is not that they don't cover the vaccine, but that coverage is delayed, CNBC reported.
According to CNN, insurance companies have 15 business days to add the shots to their plans, and as we're still in that window, some insurers haven't updated plans with the vaccine's new billing code—leading to the hefty charge.
Complicating matters further, the coverage itself is also different. COVID vaccines are now in the commercial market, according to CNBC, meaning that healthcare providers (like pharmacies) are paying for them (at over $120 each). In the past, the vaccines were purchased by the U.S. government at a discount and then distributed for free.
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Insurance companies are doing their part to resolve issues.
ShutterstockWhile it's inconvenient, insurers are aware of concerns and actively working to correct them, news outlets report.
Responding to the subscriber on X, Horizon Blue Cross Blue Shield of New Jersey wrote, "As with all previous COVID vaccines, Horizon will be covering the updated COVID vaccines as part of your preventive care benefits. We're working with our pharmacy partners and the vaccine’s manufacturers to provide coverage as quickly as possible. We appreciate your patience."
For its part, a CMS spokesperson told CNBC it is "aware that some consumers have had difficulty accessing COVID-19 vaccines, including experiencing unexpected insurance coverage denials at the point of service."
However, the spokesperson said that the company has been in “close contact with the plans about these transitions for months,” and is working to ensure systems are “up-to-date and prepared to meet their obligations to provide coverage of Covid-19 vaccines for participants, beneficiaries, and enrollees."
Cigna also confirmed to CNN that it's covering the new shot for free, and that its billing system is updated.
“COVID vaccines are covered at no cost at any in-network pharmacy or doctor’s office for Cigna Healthcare customers. If a Cigna customer believes their COVID vaccine claim was denied incorrectly, we encourage them to contact us for reimbursement,” the company said in a statement.
Pharmacies are working on getting things straightened out, too.
ShutterstockWhile insurers are responsible for covering the cost of vaccines, major pharmacies are working with them to smooth issues out.
In a statement to CBS News Boston, a CVS spokesperson reiterated that some entities are "still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines," also adding, "If this happens, our pharmacy teams can help patients schedule an appointment for a later date."
Best Life reached out to CVS for comment, but has not yet heard back.
In a statement to Best Life, Walgreens didn't specifically address existing pricing issues, but noted that the vaccines will be free for eligible patients and pharmacists are equipped to help with insurance claims.
"Walgreens is committed to ensuring no patient pays and everyone who is eligible and wants a vaccine receives one," a Walgreens spokesperson said. "COVID-19 vaccines will continue to be available at no cost to the public. The cost will either be covered by insurance or government assistance programs, such as the CDC’s Bridge Access Program. Walgreens remains focused on driving equitable and convenient access to life-saving vaccines."
The spokesperson added, "Walgreens pharmacists are aware of the procedures to process insurance claims and can assist those who have questions. We encourage everyone to bring insurance information to their appointment if available but will not turn away those whose insurance does not cover it."
