The CDC now recommends COVID-19 vaccination through shared clinical decision-making, emphasizing informed consent and personalized discussions with healthcare providers, including pharmacists. Most insurance plans are expected to continue covering the vaccine without requiring a prescription.
The most recent recommendations from the Centers for Disease Control and Prevention on COVID-19 vaccines call for “vaccination based on shared clinical decision-making,” according to a news release published Tuesday.
“Informed consent is back,” Acting Director and Deputy Secretary of Health and Human Services Jim O’Neil said. “CDC’s 2022 blanket recommendation for perpetual COVID-19 boosters deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent.”
Jen Kates, senior vice president and director of global health and HIV policy at the nonpartisan health policy organization KFF, explained the CDC is recommending that “there should be an interaction between the individual and a provider” when a COVID-19 vaccination is being considered.
That doesn’t mean that patients have to scramble to go to a primary care doctor’s office, she said, but it could create an “extra step” for patients who want to get vaccinated.
“A provider is defined broadly. That could be your pharmacist, it doesn’t have to be your primary care doctor. You don’t have to get a doctor’s visit in most states,” she said.
The bottom line, Kates said, is that, “You should be able to go to your pharmacist and have the pharmacist talk with you and then decide through that shared discussion.”
The key may be how pharmacists or insurance providers interpret the updated language in the CDC’s recommendation.
Kates said when it comes to insurance coverage, “The requirement under federal law is that any ACIP-recommended — that’s the advisory committee — and CDC-adopted recommendation on vaccines has to be covered.”
That would include private insurance along with Medicare and Medicaid, Kates said. Most large insurance companies have stated they would continue to cover COVID-19 vaccines “at least for the foreseeable future,” she said.
In Maryland, for example, Sean O’Donnell, with the Montgomery County Department of Health and Human Services, explained: “The Maryland Department of Health has issued a statewide COVID-19 vaccination standing order.”
“That authorizes qualified health care professionals to follow the most current, evidence-based guidelines as standards,” O’Donnell said. “In Maryland, that also means that a prescription is not required to get the COVID-19 vaccination.”
Shannon Dillon, a spokesperson for CVS, said their pharmacists will take part in the decision-making with patients. She said that will consist of simple conversations between the patient and pharmacist.
Dillon also said its their understanding that most insurance plans will cover the cost of vaccinations for eligible patients and that prescriptions are not required, but they should check with their insurer to be sure.
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