New Flu Shots Cost Patients $40 as Federal Vaccine Panel Remains Empty

Patients in the United States are paying out of pocket for newly approved vaccines because the federal Advisory Committee on Immunization Practices (ACIP) has no members, a gap that delays insurance coverage until at least January 2028.

The vacancy stems from a legal battle involving Health and Human Services Secretary Robert F. Kennedy Jr. A judge halted Kennedy's effort to replace committee experts with handpicked allies, citing procedural errors. Since the ruling, Kennedy has not nominated new members, leaving the panel empty while new vaccines receive FDA approval.

The immediate financial impact is visible in flu shot pricing. Ron Kroening, 63, recently received Moderna's mRNA flu vaccine, which the FDA approved in August for adults 50 and older. His insurer did not cover the shot because it is not listed as an ACIP vaccine. Kroening paid a $40 co-pay at a pharmacy that stocked the specific product.

Insurers typically have a year or more from an ACIP recommendation to add coverage for the next plan year. Because the committee is not functioning, that clock has not started for the new flu vaccine. A recommendation made in December 2026 would not trigger mandatory coverage until January 2028. A recommendation in January 2027 would push that date to January 2029.

Legal experts confirm the delay is structural. Lindsay Wiley, a law professor at UCLA, noted that the legal requirement for coverage does not take effect immediately. She described a recommendation next year as the best-case scenario for the new flu shot, but stated there is no reason to expect one to be issued promptly.

Other vaccines face similar delays, though with varying consequences. Congress mandated that insurers cover COVID-19 vaccines within 15 days of an ACIP recommendation, making them an exception to the current stall. In some states, pharmacists are barred from administering vaccines without an active ACIP recommendation, further restricting access. Insurers appear to be covering new RSV shots despite a halted September 2025 recommendation, but Medicare coverage for senior flu shots has also seen reported delays.

The federal government has appealed the court ruling that disbanded the committee, but experts say nothing prevents Kennedy from appointing new members through the correct process. Aaron Siri, who previously served as Kennedy's lawyer, wrote on Monday that the White House and the Department of Justice are not making a serious attempt to revive the committee. Dorit Reiss, a vaccines expert at UC Law San Francisco, agreed that the administration is choosing to leave the ACIP empty.

Reiss suggested that an empty committee may suit Kennedy, who previously found his appointees moved too slowly to change the vaccination schedule. By bypassing the ACIP, he can make his own recommendations. She warned that trust in the committee's independence has been undermined, suggesting that restoring it may eventually require a statute providing it legal protection.

Kroening's insurer belongs to the American Health Insurance Plans (AHIP) group, which has vowed to cover all shots recommended as of September 2025. Insurers can choose to cover vaccines before they are legally required to do so. Kroening said he would still pick the new vaccine and is glad he paid for it, though he is unhappy that insurance did not cover the cost. "It's a mess right now, what they're doing with our vaccines," he said.