By Amina Niasse and Julie Steenhuysen
NEW YORK (Reuters) -Health insurers are considering new expert sources to help determine which vaccines to pay for as anti-vaccine activist and now U.S. Health Secretary Robert F. Kennedy Jr. begins to revise government recommendations for inoculations, according to multiple insurance industry insiders and experts.
Last month, Kennedy dropped the U.S. Centers for Disease Control and Prevention’s recommendation that healthy children and pregnant women should receive COVID-19 booster shots.
He has since fired the entire 17-member panel of outside vaccine experts that reviews data for the CDC and recommends who should get them, saying they had conflicts of interest without providing evidence of any such conflicts. Kennedy then replaced them with eight of his own selections – about half of whom have advocated against some vaccines.
At least two CDC staff members have also left over Kennedy decisions. The new group meets officially on Wednesday for the first time.
Two industry organizations, two industry consultants and two insurers told Reuters that the insurance industry would continue covering vaccines recommended by the CDC panel, known as the Advisory Committee on Immunization Practices. But if ACIP drops recommendations, insurers may seek input from professional medical associations and weigh other scientific evidence, they said.
Elif Alyanak, a consultant at health firm Avalere, said insurance coverage may start to vary. Insurers are required by the Affordable Care Act to cover vaccines that are listed on the ACIP committee’s schedule, according to the CDC’s website.
“Without ACIP making that official recommendation, we won’t see the same mandated coverage,” said Alyanak, adding that health plans will need to decide if dropped vaccines were still worth covering.
That could lead to confusion for patients and providers, she said. “If a patient is vaccinated, it won’t be immediately clear whether or not they will have the coverage for it and whether the provider will be reimbursed.”
After the CDC dropped its recommendation for the COVID shot for pregnant women and healthy children, Kaiser Permanente, a California-based integrated health system that provides insurance and healthcare, said it would continue to offer it based on medical evidence. It said vaccines are part of proactively keeping members healthy.
Both the American College of Obstetrics and Gynecology and the American Pharmacists Association have said the removal of the COVID vaccine recommendation for pregnant women could threaten patient health. The APA withheld endorsement of Kennedy’s revised recommendation.
Trade group America’s Health Insurance Plans, or AHIP, said insurers will consult professional organizations like the American Association of Physicians and the American College of Obstetrics and Gynecologists as they decide what to cover.
ALTERNATIVE EXPERTS
Some public health and infectious disease experts have been organizing an alternative group to advise on vaccine use, including Michael Osterholm, director of the Center for Infectious Disease Research and Policy who served as an adviser to President Joe Biden on COVID-19. He said the group, the Vaccine Integrity Project, has been meeting with insurers.
“Given the recent developments, including changes at ACIP, we’re actively monitoring a range of expert sources to guide our approach to vaccine coverage,” said Alan Cohen, chief project officer at Buffalo, New York-based insurer Centivo, adding that it would seek input from medical societies and “credible coalitions like the Vaccine Integrity Project.”
Former CDC vaccine adviser Dr. Finona Havers, who resigned last week over Kennedy’s changes to vaccine policy, said it will be hard for any outside group to replicate the work of the CDC’s ACIP committee, and questioned whether insurers can be trusted to decide on vaccine access.
A spokesperson for a national health insurer who asked to remain anonymous told Reuters that it is too early to determine if they would look to another group to make decisions around vaccine policy.
Insurers aiming to keep health plan members healthy and lessen use of medical services would likely continue covering a yearly COVID vaccine, an independent consultant on vaccine policy told Reuters.
For other vaccines not mandated by ACIP’s immunization schedule, insurance companies will likely weigh member demographics and costs, the consultant said.
A vaccine administered during childhood targeting diseases common in older adults, such as Merck’s shot for the human papillomavirus that prevents certain cancers, could be dropped from coverage, the consultant and a second health policy expert said. But seasonal vaccines against RSV or the flu might continue to be covered because the costs of treating the illness present much sooner.
Glen Nowak, a former communications director for CDC’s National Immunization Program, said dropping vaccines might save insurers some money. “But they run the risk of losing anything they save if there are large-scale outbreaks.”
(Reporting by Amina Niasse in New York and Julie Steenhuysen in Chicago; Additional reporting by Chad Terhune in Los Angeles; editing by Caroline Humer and Bill Berkrot)
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