Empty Advisory Panel Forces Patients to Pay $40 Co-Pays for New Flu Shots

A $40 co-pay for a new flu shot illustrates the immediate cost of an empty federal advisory panel. Ron Kroening, a 63-year-old asthmatic from Oklahoma, paid out of pocket for Moderna's mRNA influenza vaccine in late 2026. His insurer denied coverage because the shot is not listed by the Advisory Committee on Immunization Practices, or ACIP, which currently has no members.

The committee has been vacant since HHS Secretary Robert F. Kennedy Jr. replaced its experts with allies, a move a judge later halted for procedural errors. Kennedy has not nominated new members. As a result, no fresh recommendations are being issued, even as the Food and Drug Administration approves new vaccines. The FDA cleared Moderna's vaccine for adults 50 and older in August 2026.

Insurance companies typically wait for an ACIP recommendation before adding a vaccine to their plans. The law requires coverage by the start of the next plan year, usually January. Without a recommendation, insurers cannot set a start date. Lindsay Wiley, a UCLA law professor, noted that a recommendation in December 2026 would trigger coverage by January 2028. A delay until January 2027 would push mandatory coverage to January 2029.

This timeline creates a window of uncertainty for patients and providers. While insurers can choose to cover vaccines earlier, they are not required to do so. Kroening's insurer belongs to the American Health Insurance Plans, which pledged to cover vaccines recommended as of September 2025. However, new shots approved after that date remain in a coverage gap.

The vacancy affects other medical decisions. Some states prohibit pharmacists from administering vaccines without an ACIP recommendation. A September 2025 recommendation for new RSV shots was halted by the court order, though insurers appear to be covering them. A voided vote to end the universal hepatitis B birth dose is also influencing state legislation. Medicare has reported delays in covering the new flu shots for seniors, despite a legal requirement that does not depend on ACIP action.

The administration is appealing the part of the ruling that disbanded the committee. Aaron Siri, a lawyer for Kennedy, wrote on Monday that the White House and the Department of Justice are not making a serious effort to revive the panel. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the government is choosing not to install a new ACIP. She suggested that an empty committee may suit Kennedy, who could then make his own recommendations without the committee's process.

Kroening said he would still choose the new vaccine and is glad he paid for it. He remains unhappy that his insurance did not cover the cost. "It's a mess right now, what they're doing with our vaccines," he said. The next step in the legal process involves the government's appeal, which remains pending before the courts.