Covid Vaccine Access and Payment – effects of the recent CDC and FDA announcements

There is a lot of noise about this year’s COVID-19 vaccines, eligibility, payment and access, most of it confusing and unproductive. Thankfully, the latest Federal recommendations have almost no effect on Oregonians’ ability to receive all vaccines on the most recent ‘real CDC’ and AAP schedule. The main effect of the inconsistent and confusing announcements from the current CDC and FDA is to increase barriers to getting vaccinated at pharmacies (where most COVID and flu vaccines are given to adults) in most of the US.

COVID-19 vaccination is approved and recommended for almost everyone because:

1. Before they were all fired, the experts at the CDC and Advisory Council on Immunization Practices (ACIP) recommended this year’s updated COVID-19 and flu vaccines for everyone.

2. The American Academy of Pediatrics (AAP) recommends routine immunization of everyone age 6–23 months, and for everyone between 2–18 years old with increased risks, including risks to others in their households.

3. The American College of Obstetrics & Gynecology (ACOG) restated its recommendation that all women who are pregnant, nursing, or planning to become pregnant receive a COVID-19 vaccine, as pregnant people have an increased risk of severe disease, adverse pregnancy outcomes, and maternal death from COVID-19 infections.

4. Both ACOG and the AAP encourage vaccination in pregnancy because it offers passive protection to newborns, who also have an increased risk of infection, complications, and death, but are unable to be vaccinated until they are 6 months old.

5. The FDA approved the new vaccines for all people 65 and older, and for those 6 months to 64 years old with at least one risk factor from the original CDC list*, which includes nearly everyone.

6. The West Coast Health Alliance recognizes that immunization is safe, effective, and offers the best protection available against respiratory viruses, and WCHA endorses broad access to the COVID-19 vaccine for anyone who chooses protection. WCHA was formed by California, Oregon and Washington in September to coordinate public health guidelines separately from the CDC. Hawaii then joined the WCHA, and it released the Consensus 2025-26 Respiratory Virus Immunization Recommendations for COVID-19, influenza and respiratory syncytial virus (RSV) vaccines.

7. Governor Kotek announced that anyone can get an updated COVID-19 vaccine without a prescription in Oregon effective Sept. 17, 2025.

8. Even the current CDC says anyone who wants a COVID-19 vaccine is legally entitled to receive one “off label” if their healthcare provider prescribes (or gives) it after “shared decision making”. “Off-label” is medicolegalese for using a medication for a diagnosis other than the official FDA approval (aka label), and “shared decision making” is the means to justify going against a recommendation based on individual differences and personal medical choices that may override population statistics. This is done all the time, especially in pediatrics, since good placebo-controlled, randomized trials are harder to do in children, and companies are rarely willing to pay for studies to support expensive applications to the FDA for labeling indications for children.

Since the federal approved and high-risk categories include almost everyone, your right to get a COVID vaccine“off label” is legally protected, and we live in Oregon, the main uncertainty is insurance coverage.

Yesterday the CDC finally released the Vaccine Price List (usually provided in June), which Medicare uses to determine cost and coverage of vaccines. Most private health insurance providers follow Medicare. In states where vaccines are only covered for the indication of the FDA approval &/or CDC recommendation we expect some insurance companies to drop coverage but most ACA-compliant healthcare plans are likely to cover the vaccine, especially in Oregon. Providence and Regence have confirmed 100% coverage, and Moda has said it will be 100% covered on most plans.

We have no control over coverage or access to more information for specific plans.

If you are concerned about cost, you should contact your insurance provider directly to ask if you meet the criteria for coverage under your plan. Consistent with our financial policy, if your insurance does not cover the vaccine, you will be responsible for the cost. Our discounted self-pay price is $198 for all ages of the Moderna vaccines. We chose the Moderna vaccine again this year because the dosing and administration are better for kids than other manufacturers’ options.