Younger adults without underlying health conditions are now eligible to get the updated COVID-19 vaccine in Wisconsin without a prescription, after Gov. Tony Evers signed an executive order making it easier to get the shot.
Following the executive order, state health officials issued a standing medical order on Tuesday, Sept. 16, authorizing the updated COVID-19 vaccine for anyone age 6 months and older, making Wisconsin one of the latest states to reject restrictions earlier placed on COVID-19 vaccine eligibility by federal officials.
That standing order allows pharmacists in Wisconsin to provide the COVID-19 vaccine without a prescription to virtually anyone. In recent weeks, pharmacists at major chains had required a prescription for anyone under the age of 65 without an underlying medical condition.
“Our hope is that … the pharmacies will all be able to move together to resemble the practice of last respiratory virus season — that nearly anyone could go get … a COVID vaccine at their local pharmacy,” said Dr. Ryan Westergaard, chief medical officer and state epidemiologist for communicable diseases with the Wisconsin Department of Health Services.
The orders are the latest in a series of actions by other Democrat-led states to push back against the approach of U.S. Health and Human Services Secretary Robert F. Kennedy Jr. on COVID-19 vaccines.
New COVID vaccines tailored to this year’s strains of the virus were made available at pharmacies across Wisconsin in recent weeks but with limits imposed by federal officials on who was eligible for the shots.
The U.S. Food and Drug Administration in August approved this year’s COVID vaccines for a more limited group of people than in previous years: adults 65 and older, and younger people with certain conditions that put them at high risk for severe illness.
That caused confusion about who could get the shot and in which states, and it raised questions about cost, coverage and access to the vaccines.
Who is eligible to get the COVID-19 vaccine?
Anyone age 6 months and older is considered eligible to get the shot in Wisconsin, under the state’s standing order.
People signing up for COVID-19 shots through major pharmacy chains CVS or Walgreens are no longer required to attest to having an underlying condition.
And people without an underlying condition no longer need a prescription to get the shot in Wisconsin, spokespeople for the pharmacy chains confirmed.
The pharmacy chains now only require people signing up online to check a box saying they would like to receive the COVID-19 vaccine and are eligible.
Will health insurance cover the new COVID-19 shots?
Most health insurers appear to be covering the updated shots, for the time being.
America’s Health Insurance Plans, a national trade group for health insurers, said in a statement its member health plans will continue to cover COVID-19 shots with no cost-sharing for patients through the end of 2026. Its member health plans include major insurers Aetna, Humana and Elevance Health, previously known as Anthem.
In a statement, UnitedHealthcare said for its standard commerical plans, it would continue to cover claims for COVID vaccines with no cost-sharing. It said coverage with no cost-sharing is also available to its Medicare and Medicaid members.
The Wisconsin Association of Health Plans, a trade association that represents more than a dozen local health plans, did not immediately respond to an email with questions.
The Wisconsin Office of the Commissioner of Insurance, which regulates health insurers, issued guidance on Sept. 16 saying it expected insurers to cover, without cost-sharing, all costs associated with the administration of COVID vaccines for patients.
“A coverage design that provides immunization coverage without cost-sharing for some but not all similarly situated insureds may constitute impermissible discrimination unless justified by sound actuarial or medical evidence,” the guidance says.
The Advisory Committee on Immunization Practices, a panel of experts that advises the U.S. Centers for Disease Control and Prevention on vaccine policy still has not issued recommendations for who should receive the latest COVID vaccine, a decision that could affect how and whether health insurers cover the shots in the future.
The panel is slated to meet Sept. 18-19 and may vote on COVID vaccine recommendations.
This article originally appeared on Milwaukee Journal Sentinel: New COVID-19 vaccine now available without a prescription to all Wisconsinites, after Gov. Evers order
Reporting by Sarah Volpenhein, Milwaukee Journal Sentinel / Milwaukee Journal Sentinel
USA TODAY Network via Reuters Connect
