COVID vaccine restrictions cause confusion for WV residents, raise insurance questions

Further complicating matters, the Centers for Disease Control and Prevention’s Committee on Immunization Practices has not yet met to decide on its recommendations for the vaccine.

Because West Virginia law requires pharmacists to have a valid prescription for a vaccine they administer unless the shots are on the CDC’s list of recommended vaccines, West Virginians currently seeking the vaccine at local pharmacies will need a prescription, Gailyn Markham, a spokeswoman for the state Department of Health, said in an email.

The CDC’s Advisory Committee on Immunization Practices is expected to meet Sept. 18 and 19 to consider their COVID-19 vaccine recommendations.

An official for the West Virginia Board of Pharmacy wrote on the agency’s website that with a prescription, state pharmacists may administer an age-appropriate COVID shot to those age 3 and up prior to the ACIP recommendations. The board plans to update guidance for pharmacists after the ACIP meeting.

The FDA changes this year have caused confusion for West Virginians seeking the vaccine. They’ve raised questions for local health departments about coverage of the shot and increased demand for the shot at local health departments.

Shawn Taylor, an attorney and city councilman in ÂÒÂ×ÄÚÉä, said he scheduled an appointment with a local Walgreens pharmacy to get both the flu and the COVID-19 vaccines. He had planned a trip and wanted to avoid getting a virus from a crowded airport or a plane.

Taylor, 59, said he got mixed messages from his doctor’s office and the pharmacy about whether he could get the COVID-19 shot with a prescription from his doctor. His primary care office was willing to write one, but they weren’t sure if the pharmacy would have given him the shot even with the prescription.

He ended up not bringing the prescription to his Walgreens appointment. When he got there, a pharmacy employee told him they would have given him the shot with a prescription.

“I ended up not getting the coronavirus vaccine,� Taylor said. “I did get my flu shot.�

Taylor plans to go back to his primary care physician to get his prescription and try again.

“But heck, it doesn’t do me a lot of good if I end up getting the coronavirus while I’m flying from coast to coast,� he said.

Taylor said he’s gotten the vaccine seasonally since it became available. He’s concerned about the possibility of going without it this year. As a self-employed attorney, Taylor said he can’t afford to be off of work because of sickness.

“If I don’t work, I don’t earn any money, I don’t have a paycheck,� Taylor said. “I have to be able to be in motion. I have to be able to perform.�

Brigid Sweeney, a spokeswoman for Walgreens, wrote in an email that the pharmacy is offering the vaccine with a prescription to those over age 65 and to those under age 65 with an underlying condition.

Questions for health departments

Dr. Brian Huggins, health officer for the Monongalia County Health Department in Morgantown, said besides the FDA restrictions, the state has not issued any guidance to local health departments about this year’s changes.

“Ultimately, we’re just making decisions on our own at the local level,� Huggins said.

Markham, the Department of Health spokeswoman, said it’s up to local health departments whether they want to stock the vaccine for this fall.

As of Wednesday, the health department hasn’t received the vaccines, but they’re getting a lot of questions about it, Huggins said.

“In the meantime, I have been e-prescribing the vaccine for patients that we have been seeing in our clinic for other appointments and they have been able to get the shot at local pharmacies with the e-script,� he said.

The big question, Huggins said, is whether private health insurance companies will cover the vaccine this year, and whether the vaccine will be included in those supplied through the federal government’s Vaccines for Children program.

While the FDA has narrowed its recommendations, some health care groups have issued their own differing recommendations. The American Academy of Pediatrics recommends the vaccine for children ages 6 months to two years and to older children who are immunocompromised or in certain other risk groups. The CDC earlier this year removed the recommendation that pregnant people get a COVID shot, but the American College of Obstetricians and Gynecologists continues to recommend it. Some states — excluding West Virginia — have even issued their own standing orders for the vaccine, expanding access to the shot.

Huggins said the state health department wouldn’t typically offer guidance to health departments about COVID-19 shots, but until this year, there hadn’t been controversy and conflicting recommendations related to the vaccines.

“I think that’s part of the problem here, is that we’ve never seen where a vaccine that was previously more globally authorized by the FDA that has kind of a retraction, right? I think that’s the confusion at the health department level,� Huggins said. “Normally we would just order vaccines. We can give vaccines because, of course, most insurance companies are just automatically going to pay for people that need to get their vaccine.�

Will your insurance cover a COVID shot?

MCHD made the decision to stock enough COVID-19 vaccines to provide to people over 65 because Medicare should pay for them, he said.

“What we don’t know for sure is what is it going to take to get the shot paid for by an insurance company?� Huggins said. “We believe it would be that if you have one of the qualifying health conditions and you’re under the age of 64 then they in, in theory, the insurance company will pay for it. The problem is, it’s a very expensive vaccine.�

According to the CDC’s vaccine price list, the adult dose of COVID vaccine costs around $140 for the private sector.

Cathy McAlister, a spokeswoman for Highmark Blue Cross Blue Shield West Virginia, an insurance company that covers about 250,000 people, said the insurance company has not changed its policy for covering the COVID-19 shot.

“We will cover COVID shots for people whose physicians say it is necessary, including those who are not in the high-risk category,� McAlister wrote in an email. “Additionally, members should be always consulting with their physician about personal health care needs.�

The insurance company itself won’t require a prescription, she added, but some clinics and pharmacies may require one.

The Kanawha-ÂÒÂ×ÄÚÉä Health Department started offering the COVID-19 shot beginning this week, according to a news release from the agency. The health department is prescribing the vaccine under a standing order from KCHD Health Officer Dr. Steven Eshenaur. The department is not requiring a separate physician’s order if patients attest to having one of the CDC’s list of risk factors for severe illness.

Eshenaur said the department’s vaccine management company, VaxCare, has raised questions about whether insurance plans will cover the shot before the CDC committee issues its recommendations.

“What we have found is that we are getting a number of red lights, per se, or a stop from VaxCare as they run it through the various third-party payers, even for people that meet the guidance per the FDA,� Eshenaur said. “So, for instance, somebody 67 — everybody over 65 is recommended to receive the COVID vaccine and still getting a partner bill coding — meaning that we have to bill the individual’s insurance ourselves, because they have not gotten back authorization from that third-party payer.�

By Wednesday morning, the Kanawha health department’s COVID vaccine supply had run low. Eshenaur said people were coming to the health department after being told at a pharmacy that they need a prescription for the shot.

“We may actually run out of COVID vaccine as early as today, because we have such unanticipated high demand compared to our numbers last year,� Eshenaur said Wednesday morning. “Because people just can’t go to the pharmacy and get it.�

In a news release Wednesday afternoon, KCHD said it had run out of the vaccine, but would order more.

“It shouldn’t be long until our COVID vaccine supply is replenished,� Eshenaur said in the news release. “We are also working through insurance issues as they arise. This situation is fluid for sure, but our priority is always to take care of the public.�