What you need to know about getting the COVID-19 vaccine in Michigan

New FDA rules restrict access to COVID-19 vaccines for people under 65 unless they have underlying health conditions
Physician groups and Michigan public health experts still recommend broader COVID vaccination despite the federal limits
Vaccines remain available at Michigan pharmacies without prescriptions, but insurance coverage may change based on upcoming federal committee decisions

Michigan residents are accustomed to COVID-19 shots being widely available, but new guidelines from the federal government have put the broad availability of the vaccine on shaky ground.

“My recommendation is to get your COVID vaccine at the first available opportunity,” Michigan’s chief medical executive Dr. Natasha Bagdasarian told Bridge Michigan.

In August, the US Food and Drug Administration approved updated COVID-19 vaccines but imposed new restrictions on many groups that previously qualified to receive them.

Previous versions of the vaccine had been approved for everybody older than 6 months up.

Under the newly approved license, people 6 months through 64 years old will need at least one underlying condition that puts them at high risk for severe outcomes from COVID-19 to qualify. People who are 65 years and older can still access the mRNA vaccines from Pfizer, Moderna and Novavax.

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US Health and Human Services Secretary Robert F. Kennedy Jr. outlined the new framework on X, saying the FDA’s authorization applies to manufacturers differently. While Moderna’s vaccine is approved for qualified individuals 6 months and older, Pfizer’s availability starts at 5 and Novavax at 12.

Still unresolved is how the FDA’s determination will impact insurance coverage for the updated vaccine. That decision falls to the Advisory Committee on Immunization Practices (ACIP), which is set to meet Sept. 18.

The committee crafts the federal government’s official guidance on vaccines, and its recommendations determine how private insurance companies, Medicare, Medicaid and the free Vaccines for Children Program pay for treatment.

Kennedy fired all advisory committee members this summer and replaced the board, including appointing some members known to be vaccine skeptics. Many public health experts are bracing for the group to rescind recommendations for important childhood shots, just as Florida moves away from mandating vaccination at schools.

“If they change their guidance on COVID-19, it is possible that people will see a change in health insurance coverage of COVID vaccine. We are still waiting to see what happens,” Bagdasarian explained.

“At this point, it’s anyone’s guess.”

Can I get the shot if I don’t meet the new restrictions?

Yes, but it may not be easy.

The FDA’s updated license will likely create new challenges to getting vaccinated, according to public health experts. Groups that do not meet the current standards could still receive the shot “off-label” from their health provider or pharmacist, but insurance may or may not cover that.

Bagdasarian said access to the COVID-19 vaccine may depend on how individual providers choose to interpret the FDA label.

“If you do not neatly fit into a category where you’re over 65 or have a health condition … there are some pharmacies that may be more restrictive in who they choose to immunize,” she said.

What do doctors say?

The federal government’s COVID-19 vaccine guidance is at odds with the broad consensus of public health experts and physicians.

The recently ousted head of the US Centers for Disease Control and Prevention reportedly left the agency over disagreements with Secretary Kennedy’s vaccine policy and several of its past directors have called the administration’s recommendations on immunizations “dangerous and unfounded.”

Most health care professionals, researchers and health agencies promote the vaccine as being safe and effective. While the COVID shots can cause soreness, chills and fatigue, studies indicate the vaccines rarely cause long-term side effects.

Those that take the vaccine are significantly less likely to get COVID-19, get seriously ill when they fall sick and get hospitalized.

The American Academy of Pediatrics says all children should get the vaccine, and the American College of Obstetricians and Gynecologists recommends the COVID-19 shot at any point during pregnancy.

The Michigan Department of Health and Human Services aligns itself with the medical community, Bagdasarian said.

“If you are a healthy individual who does not fall into those age groups, we still believe you should have the option to get COVID vaccine if you want to protect yourself from those severe complications of COVID,” she said.

Leaders at the Michigan Health & Hospital Association (MHA) echoed the overall efficacy of vaccines, saying medical decisions and questions should be addressed between patients and their providers.

“The association does not provide guidance related to vaccine administration,” MHA chief medical officer Dr. Gary Roth said in an emailed statement to Bridge. “Our role is to support hospitals in their efforts to increase overall vaccination uptake and avoid the spread of vaccine preventable diseases, as the evidence is indisputable that vaccines are the best tool available to prevent severe illness and save lives.”

Where can I get a vaccine?

Vaccines, including the COVID-19 vaccine, are generally available at doctor’s offices, pharmacies, health centers and local health departments.

Many sites are awaiting delivery of the reformulated COVID vaccine following the FDA’s approval, according to pharmacies and public health experts contacted by Bridge.

The CDC has traditionally provided a searchable database of vaccine providers. Bridge made numerous attempts to use the search function this week, but as of Thursday afternoon, it was not working. The site displayed a banner at the top warning of functionality issues during a website update.

Children’s Hospital Boston has a similar website that allows users to locate vaccines by providing a 5-digit ZIP code.

Will I need a prescription?

CDC data indicates retail pharmacies are the most common way people access the COVID-19 vaccine.

Despite reports that pharmacies in some other states are requiring people to have prescriptions to get the shot, Michigan does not require a physician’s note, according to the state health department.

Farah Jalloul, chief pharmacy officer of the Michigan Pharmacists Association, said drug stores will continue to provide vaccines as they have been “until we hear otherwise.”

“Pharmacists are still practicing under a collaborative practice agreement that allows them to immunize,” Jalloul said. “Reach out to your pharmacy … we are there to help you.”

In 13 other states and the District of Columbia, CVS has indicated it will require prescriptions. Walgreens has made similar decisions.

“State pharmacy laws govern where we can currently vaccinate,” said CVS spokesperson Ethan Slavin in an email. “Once ACIP acts on the updated COVID-19 vaccines or states take additional action to authorize pharmacy dispensing prior to ACIP recommendations, we’ll be able to offer the FDA-approved COVID-19 vaccines in the remaining states.”

Will my insurance cover the shot?

Vaccine coverage may vary depending on the insurance provider.

Blue Cross Blue Shield of Michigan, the state’s leading health insurer, said the safety and efficacy of vaccines have been proven for decades and it will continue the COVID-19 shot as part of its covered benefits.

“We want to reassure our members and customers that, at this time, there are no adjustments to our coverage for vaccines,” said BCBSM spokesperson Brianna Neace in a statement.

Michigan’s other health insurance companies have not issued specific guidance amid the changing framework.

“It is my understanding that our member health plans will likely follow the FDA’s guidance regarding the COVID-19 vaccination,” said Brian Mills, a spokesperson for the Michigan Association of Health Plans (MAHP) in an email. “Customers are encouraged to contact their respective insurance provider with any specific questions about their policy coverage.”

The federally funded Vaccines for Children program offers free shots to kids, and both Medicaid and Medicare have covered the vaccine.

According to the CDC, the cheapest COVID-19 vaccine for adults cost private insurers $136.75 this month with out-of-pocket costs north of that.

What about other vaccines?

State officials report no change in access to vaccines for seasonal influenza and respiratory syncytial virus (RSV) in Michigan.

“Guidance, coverage, availability for flu vaccine and RSV vaccines has not changed,” Bagdasarian said.

The flu vaccine is recommended by the CDC and physician groups to everyone 6 months and older. The RSV shot is recommended for all adults over 75 years old and those older than 50 with increased risk factors.

The RSV vaccine is also recommended during pregnancy, and maternal antibodies can protect newborns in the first 6 months of life. Babies whose birthing parent did not receive the vaccine are recommended to receive RSV monoclonal antibodies, which can reduce the risk of hospitalization by 80%.

While the FDA is reviewing the matter, prominent physician groups, hospitals and studies have found it safe to get COVID-19, flu and RSV vaccines at the same time.

Do I still need the COVID-19 vaccine?

It depends.

Doctors and researchers say built-up immunity from prior infections or immunizations can help protect against the worst effects of COVID-19.

But higher risk individuals, like older adults and those with an underlying health condition, can still be gravely harmed by the disease. Fall and winter surges are still possible and can increase the chances of infections for all individuals.

Vaccines, which are internationally recognized as being very safe, can offer protections at little risk, with many recommending getting the vaccine annually. Those seeking the shots should wait 3 months after a recent infection or their last dose of the vaccine.

COVID-19 infections and deaths are still being reported around the globe.

According to the World Health Organization, more than 778 million cases have been reported since the disease’s inception with more than 7 million reported deaths.

Michigan has reported an average of 53 cases every day as of June 21. More than 46,000 residents have died from COVID-19 since reporting started.