Americans seeking out a new COVID vaccine are reportedly being hit with sticker shock thanks to the vaccine’s current pricing.
Take Glen Cote of Acton, Massachusetts. While recently en route to CVS for a COVID vaccine appointment, he received a text message informing him that he owed $190.99.
“Nightmare is the first word that comes to mind,” he told local station WBZ when asked about the unexpected bill.
The bill came as a shock, especially given as most CVS stores reportedly have signs outside that read “FREE FLU & COVID-19 vaccines here.”
Yet Cote isn’t alone in being billed:
The brand new covid vaccines are available at CVS in New York area but the Gov’t has not paid for them and so friends on Medicare were turned down yesterday or told to pay $125.
— Susan Isla Tepper (@IslaTepper) September 16, 2023
Meanwhile, Chicago resident Eric Allix Rogers was billed $155.99 for the vaccine last week because his insurer, Blue Cross Blue Shield of Illinois, wouldn’t pay for it.
Because he previously had a “bad case” of COVID and didn’t want to risk getting reinfected prior to a “large work event” this upcoming week, he went ahead and paid it.
“We are being told we have to transition to treating covid as a routine matter and yet the people responsible for medical care have not figured out how to treat it as a routine matter. This shouldn’t have been complicated,” he told The Washington Post.
According to the Post, there’s an explanation for all this.
“The hiccups reflect a new reality for covid vaccines as they go from being treated as a public good to a commercial product. Now that the federal government is no longer buying and distributing all the shots, Americans must endure the usual headaches of dealing with insurance companies and a for-profit health care system,” the Post noted.
In a statement to the newspaper, CDC director Mandy Cohen offered her own explanation: “Last year there was one player — the federal government. And now there’s a lot more players and … they’re not accountable to us.”
The COVID vaccine was previously covered by the federal government under the Public Health Emergency until it expired earlier this year. That said, the vaccine is supposed to be covered by most private/public health insurers going forward.
And indeed, a spokesperson for Rogers’ insurer, Blue Cross Blue Shield, told the Post that customers are entitled to a free vaccine at “in-network providers,” which evidently doesn’t include CVS at the moment.
Hey @FLBlue: do your job and add the new, long-awaited Covid-19 vaccine to your pharmaceutical formulary. Any insured member trying to get it at a pharmacy is being told it’s not approved and will cost $155. There’s no excuse for this.
— Sarah Lindsey (@SarahLJewelry) September 18, 2023
The Post notes that in July, Centers for Medicare & Medicaid Services administrator Chiquita Brooks-LaSure submitted a letter to insurers telling them to be ready to cover the cost of the COVID vaccine starting in fall.
“After hearing reports of unexpected insurance denials, CMS has been working with plans to ensure their systems are up to date and is reminding them they must immediately cover authorized covid vaccines without cost sharing,” the Post notes.
According to WBZ, there’s also been some sort of billing code issue.
“[T]he new vaccines have a new billing code for insurances – which has not been updated in all insurance plans, leading to the erroneous charge for people seeking out a vaccine in this first week,” the outlet notes.
“Some payers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines. If this happens, our pharmacy teams can help patients schedule an appointment for a later date,” a CVS spokesperson explained.
For the time being, however, the current sticker shock is too much for some.
Out of curiosity, I just called CVS to see what the cost of a new Covid vaccine would be without insurance.
Pharmacy staffer says it’s $190.
No more free poison for you!
— Jordan Schachtel @ dossier.today (@JordanSchachtel) September 19, 2023
“Being healthy is important but paying $200 for a vaccine shot is too much,” Lafayette, California resident Ryan Dougherty told local station KNTV.
“Of course, that’s much too expensive,” Lafayette resident Cinda Ely added.
Meanwhile, there are reportedly also logistical issues at play.
“[T]here have also been reports of Americans struggling to find places offering the new vaccines or having their appointments canceled. Administration officials said manufacturers and distributors are working to resolve logistical issues that have caused some delays and that there is no vaccine shortage,” according to the Post.
But sadly, it appears greed is also a factor.
“COVID-19 vaccine manufacturers, which charged the federal government about $29 per dose for the last vaccine booster, are now billing pharmacists 3-4 times that amount on the commercial market, according to research from Kaiser Family Foundation,” as reported by The Albany Times Union.
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