ALBANY — As large retail pharmacies compete for market share in the latest COVID-19 vaccine roll out, it might be wise to hold off on making an appointment.
Chain stores like CVS and Walgreens ordered the new doses early, opening up vaccine appointments as early Saturday and Sunday. But by Thursday, many consumers in the Capital Region reported receiving calls from their pharmacists advising them to reschedule or risk paying $200 out-of-pocket for the immunizations.
A representative for CVS, which declined to make a pharmacist available for an interview, said some insurers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines.
"If this happens, patients are encouraged to check with their plans for more details and schedule an appointment at a later date," CVS spokeswoman Tara Burke said.
Consumers with Empire Blue Cross were among those who received calls advising they cancel their appointments.
A spokesperson for Empire Blue Cross said "a very small number of members’ claims (were) rejected because pharmacies had access to the new COVID vaccine early, and our system was prepared based on the CDC timeline communicated for availability of the vaccine. Those rejected claims will be re-processed, and the members will receive their vaccines at a $0 copay."
According to CDPHP, the Capital Region-based health plan will continue to cover COVID-19 vaccines at no out-of-pocket cost and is in the process of communicating the new billing codes to pharmacies.
The Centers for Disease Control and Prevention approved the shot Tuesday, recommending the vaccine for everyone ages 6 months and older this fall.
The 2023-2024 COVID-19 vaccine is designed to block XBB variants and has been shown to provide some protection against other emerging variants.
Medicaid and commercial insurance plans are required to cover the immunizations without charging a co-pay.
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.
The $200 price tag for consumers has raised concerns about the uninsured having access the immunizations.
While New York's uninsured rate dropped to a record low during the three-year pandemic — when Medicaid eligibility checks were paused — the state's Medicaid program resumed eligibility checks in May and at least 300,000 New Yorkers have already lost coverage, according to state data submitted to the Centers for Medicare & Medicaid Services tracked by the KFF.
New York is offering vaccines free of charge to the uninsured through community clinics, county health departments and addiction treatment centers.
Given the limited shelf-life for the vaccine doses, many smaller pharmacies and pediatrician offices are waiting and see what the demand is like before ordering their supplies.
Assemblyman John McDonald, a pharmacist in Cohoes, said the cost to pharmacists is $145 per dose, which may discourage small primary care and pharmacy businesses from carrying the shot.
"To give you a perspective, flu vaccine has been relatively stable for over the past umpteen generations and it's around $25 to $30 a dose," McDonald said. "This is significantly higher, and to be honest with you, for small businesses that's going to cause problems ... Someone's not going to shell out $5,000-$7,000 with the hopes of getting that money back in a month."