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Health insurers in Pennsylvania will be required to cover COVID-19 and other vaccinations through 2026.
All accident and health insurance policy issuers in the commonwealth will have to cover vaccinations “without cost-sharing and the imposition of other administrative barriers”, under a notice issued Friday by the Pennsylvania Insurance Department.
That means Pennsylvanians can receive the COVID-19 vaccinations without copays, deductibles, or other costs, when administered by an in-network provider and without insurers requiring extra steps that make it harder for people to get vaccinated. It also allows pharmacists to follow guidance from a number of trusted medical organizations when giving vaccines.
It also encourages insurers that handle employer-funded health plans, which are not directly regulated by the commonwealth, to ensure that access to vaccines remains consistent for their insured.
The directive comes in response to changes at the Centers for Disease Control that could make obtaining the vaccine more difficult across the country.
“This is about keeping promises to Pennsylvanians. Vaccines are one of the best ways to prevent serious illness, and we want every Pennsylvanian to have affordable, easy access to protect themselves and their families,” Insurance Commissioner Michael Humphreys said in a statement. “If your health insurance plan says it covers vaccines, that coverage will remain in place at least through 2026. It should be easy for you to get vaccinated.”
The agency has received numerous questions about vaccine coverage following the CDC’s actions this year, according to the notice published in Saturday’s issue of the Pennsylvania Bulletin.
The CDC recently dropped its universal COVID-19 vaccine recommendation, as well as other changes to its immunization schedule that include toddlers receiving the measles, mumps and rubella shot separately from the chickenpox vaccine.
“Informed consent is back,” declared Acting CDC Director and Deputy Secretary of Health and Human Services Jim O’Neill upon approving the changes Oct. 6.
The CDC’s 2022 blanket recommendation for the COVID-19 immunization “deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent”, O’Neill said.
The CDC’s Advisory Committee on Immunization Practices (ACIP) had recommended changes to the immunization schedule in September – a few months after all 17 members of the committee were removed and replaced by U.S. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime and outspoken vaccine skeptic.
Kennedy gutted the committee – a panel of experts who issue guidance for the nation’s doctors and pharmacists – shortly after he declared the CDC would no longer recommend COVID-19 vaccines for healthy children and pregnant women. He didn’t cite any specific studies and potentially put the authority’s guidelines at odds with professional associations representing thousands of pediatricians, gynecologists, family doctors and scientists across the country.
Historically, Pennsylvania’s Board of Pharmacy has followed the recommendations of ACIP. But on Sept. 3, the board unanimously approved a measure allowing the agency to issue vaccine guidance based on the recommendations of three medical professional societies: the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists, as well as the U.S. Food and Drug Administration.
The commonwealth also joined a coalition of northeastern states to coordinate on public health efforts such as emergency preparedness and the creation of immunization guidelines.
Other states in the Northeast Public Health Collaborative (NEPHC) include Connecticut, Delaware, Massachusetts, New Jersey, New York, Rhode Island and Vermont. All have Democratic governors, except Vermont which is run by Republican Phil Scott.
Gov. Josh Shapiro signed an executive order Oct. 1 that directs state agencies to safeguard vaccine access through the creation of a vaccine safety net for children and by aligning policies with medical experts.
The order also launched a central vaccine portal and a vaccine education workgroup to improve public communication and fight misinformation.
“Importantly, the executive order reinforces that recommended vaccines should remain covered under both private insurance and Medicaid in Pennsylvania. This step ensures that whether someone has a state or private plan, their access to immunizations is protected and consistent,” the Insurance Department said.
